I WILL BE YOUR MODERATOR FOR
THE SESSION.
SO OUR FIRST SPEAKER IS
Dr THIELSCHER
AND HE WILL TALK ABOUT
IMAGING.
>>THANK YOU AND GOOD MORNING,
EVERYBODY.
[ NOT SPEAKING DIRECTLY IN MIC
]
AND AS AN AGENT OF BASE AND
THE SUBSET --
[INDISCERNIBLE]
ONE IMPORTANT THING HERE IS TO
REALIZE THAT --
[INDISCERNIBLE]
AND THERE ARE QUITE A FEW
SOURCES OF ERRORS THAT CAN
MAKE THAT BAD IN A WAY.
ONE THING IS THE.
[INDISCERNIBLE]
AND MOST LIKELY THE ONE WITH
THE BETTER SKULL -- AND OFTEN
IT WILL HAVE MORE BIASES WHICH
ARE REALLY DIFFICULT AND TO
KNOW WHAT IS BETTER AND THERE
ARE ALSO SOME SERIES ON
PROTOCOL AND AN IMPORTANT
TOPIC IS THE POINT OF
CONDUCTIVITY.
THEY ARE NOT ACTUALLY VERY
WELL-KNOWN AND I WANT TO GIVE
ONE EXAMPLE HERE, THE
SUBJECTS, ONE WITH A THINNER
SKULL, THE OTHER WITH A
THICKER SKULL BUT THAT IS NOT
THE ONLY THING.
THE THINNER SKULL IS MUCH
DARKER WHICH MEANS A HIGHER
FEROCITY, LESS ENTITY AND THEN
THE THICKER SKULL, YOU SEE THE
DIFFERENCE BETWEEN THIS SKULL
AND THAT SKULL.
[INDISCERNIBLE]
HOW TO VALIDATE, THIS IS ONLY
POSSIBLE IN ANIMAL MODELS AND
YOU HAVE TO BE VERY ACCURATE.
AND IN TOTAL, YOU CAN MIX THIS
OUT WHICH IS WHY INTERESTING,
FOR SOME WITH SIMULATIONS, THE
OTHERS NOT SO THAT POINTS TO
THE NEED TO IMPROVE ON THE
MEDIUM MODEL AND THAT IS WHERE
THIS COMES IN, THE PRINCIPLE
VERY SIMPLE.
AND WE CALL THAT THE
CURRENT-INDUCED MAGNETIC
FIELD.
IT IS NONINVASIVE, REPEATABLE
AND SELF VALIDATING WHICH I
WILL COVER LATER AND THEN
POTENTIALLY DENSER
MEASUREMENTS COMPARED TO
INVASIVE RECORDINGS.
SO WE HAVE THE R & L AND THEY
GO ONE WAY INTO THE HEAD AND
THE OTHER WAY IN THE HEAD AND
IT SHOWS SLIDES OF THE IMAGES
BY TAKING THE DINNERS BETWEEN
THOSE IMAGES, YOU CAN
RECONSTRUCT THE CURRENT
INDUCED MAGNETIC FIELD AND
FROM THAT TIE TO RECONSTRUCT
THE CURRENT FLOW THROUGH THE
EYE AND YOU HAVE TWO PARTS,
THE MEASUREMENT AND THE
RECONSTRUCTION.
AND THE MEASUREMENTS --
[INDISCERNIBLE]
MEANING YOU WANT TO MEASURE
THE HIGH SENSITIVITY AND IMAGE
QUALITY, AND HAVE A DIFFERENCE
OF ONE MILLIMETER WHICH IS
DIFFICULT TO BE DONE AND AT
THE SAME TIME YOU WANT TO
REDUCE BIASES.
BEFORE I COME TO MEASUREMENT
TECHNIQUES WHICH WE HAVE BEEN
DEVELOPING, I WANT TO SAY A
FEW WORDS ABOUT THE
MEASUREMENT SETUP, THAT IS HOW
IT LOOKS HERE, YOU HAVE SOME
MEASUREMENTS ON THE SIDE OF
THE HEAD AND THE CABLE CREATE
MAGNETIC FIELD AND THIS HAS
BEEN SUPER IMPOSED ACTUALLY
THROUGH METAL.
SO IN A SIMULATED SITUATION,
YOU HAVE THE SKIN WITH THE
ELECTRODES, THE YELLOW THING
HERE, THE SLIDE AND YOU SEE
THE CABLES HERE AND BY
ELEVATING THEM, THEY APPEAR
QUITE STRONG AND THEN WHEN
ELEVATING THEM THROUGH SIMILAR
MAGNETIC FIELDS, THEY ARE
VERY, VERY SIMILAR.
SO HERE YOU SEE THE CURRENT
WITH CALCULATED LEAD STRAY
FIELDS AND HERE WE HAVE THE
MEASURED CALCULATIONS OF THE
HEAD.
SO LONG STORY SHORT, THE
MAGNETIC FIELDS OF THOSE
CABLES DON'T HAVE A STRONG
SATURATION BY WHICH THEY ARE
MEASURED IN IMAGE 2 AND AS
THEY ARE IMPROVED, WE GET VERY
DIFFERENT MEASUREMENTS.
WHAT WE CAN DO AS WE CALCULATE
SOME FIELDS, WE CAN GET
UNBIASED MANIPULATION OF THE
CABLE INDUCED FIELD.
IT IS NOT ONLY THAT WITH THE
CABLE-INDUCED FIELD BUT WE ARE
ABLE TO MAKE SOME VERY NICE
RESIDUALS SO HERE YOU HAVE THE
CABLE AND WE COMPARE THEM TO
SEE --
[INDISCERNIBLE]
SO HERE YOU HAVE THE STRONG
FIELDS AND COME FIRE
MEASUREMENTS XYZ, YOU CAN SEE
THE DIFFERENCE ALONG THIS
LINE.
SO BASICALLY IT IS A NICE WAY
OF VALIDATING YOUR
MEASUREMENTS TO SHOW THEY ARE
UNBIASED AND RELIABLE.
THIS IS AN EXAMPLE WE FOUND
THAT SHOWS THE PROBLEM AND YOU
CAN SEE THAT THE RF IS NOT
THERE.
SO I THINK EVERYBODY DOING
THIS EXPERIMENT NEEDS TO LOOK
AROUND TO MAKE SURE THE
MEASUREMENTS ARE WORKING OUT
AND TO GET A GOOD ESTIMATE.
SO I HAVE A FEW SLIDES ABOUT
THE OPTIMIZATION AS WELL.
IT IS QUITE ANOTHER THING TO
MEASURE MAGNETIC FIELDS SO
WHAT WE DID IS TO TRY TO
OPTIMIZE THE EFFICIENCY OF THE
SEQUENCES, BASICALLY HOW MUCH
SNR YOU GET THROUGH A PERIOD
OF TIME.
WE STARTED BY, YEAH, SCREENING
SOME SEQUENCES SO SELECTING
THE MOST IMPROVED ONE AND YOU
CAN DO THAT SYSTEMATICALLY
BOTH IN SIMULATIONS AND THEY
MEASURE QUITE NICELY HERE,
THEY HAVE A SWEET SPOT AROUND
HERE THAT IS RELATIVELY SHORT
SNR AND THIS IS DOMINATED BY
THE TISSUE PROPERTIES --
[INDISCERNIBLE]
AND THIS ALSO MEANS WHEN YOU
HAVE THE DOPED SALINE WITHIN
THE PARAMETERS, YOU HAVE
REDUCED SNR.
WE ALSO HAVE IMPROVED ON THE
ROBUSTNESS AND SNR R AND
IMPROVED READOUT SO AT THE
END, YOU CAN GET VITAL
ESTIMATES OR MEASUREMENTS OF
THE CURRENT INDUCED MAGNETIC
FIELD.
THIS WOULD BE A LARGE
MEASUREMENT FOR THE SCAN SO
TALKING REALLY ABOUT A SINGLE
SLIDE PER MINUTE AND YOU SEE
THE MEASUREMENT GETTING A VERY
NICE AND STABLE PATTERN AND WE
START ACTUALLY SEEING EFFECTS
OF THE MEASUREMENTS.
THESE CURVES HERE COME FROM
THE FACT THAT WE HAVE
VENTRICLES WHICH ARE SHUNT A
LITTLE BIT AND THAT SHOWS UP
IN THE MICROMEASUREMENTS.
LAST THING WE SEE IS INCLUDING
VOLUME COVERAGE GOING FROM ONE
SLIDE TO SEVERAL SLIDES AND ON
SNS AND MODEL POSITION, THEY
ARE QUITE GOOD QUALITY IN TEN
MINUTES AND GET SENSITIVITY
INCREASE COMPARED TO WHERE YOU
HAVE --
[INDISCERNIBLE]
ON THIS SLIDE YOU SEE THEY ARE
ACTUALLY QUITE GOOD AND BY
REPEATING THE SLIDE A NUMBER
OF TIMES, YOU CAN SEE THE SNR
IS QUITE A BIT BIGGER.
WITH THAT I THINK WE ARE QUITE
GOOD ON THE MEASUREMENT SIDE
AND WE CAN SEE THE
MEASUREMENTS WORK OUT
RELIABLY, AND WHAT CAN WE DO
WITH THE DATA.
NOW WE WANT TO RECONSTRUCT THE
FIELD AND IF RECONSTRUCTION OF
CURRENT FLOW AND
CONDUCTIVITIES, IT IS
DIFFICULT BECAUSE WE DON'T
HAVE THE DATA, WE HAVE
RELATIVELY LOW SNR AND
INCOMPLETE DATA WITH NO FULL
3D COVERAGE.
SO--
[INDISCERNIBLE]
SO FAR IN HUMANS, WE HAVE THE
VOXELWISE AND THAT WOULD BE
THE INPUT MEASUREMENT AND IT
LOOKS LIKE THAT.
FOR EXAMPLE, HERE ON THE
SLIDES, WE DON'T SEE ANY
MEASUREMENTS OF THE VENTRICLES
SO WE BETTER UNDERSTAND WHAT
WENT WRONG IN THIS TYPE OF
APPROACH AND THERE WE START
WITH A SIMPLE CASE THIS, DATA
HAS MODELS AND IN THE CURRENT
FLOW, WE CALCULATE THE
MAGNETIC FIELD AND CONSTRUCT
THE ALGORITHM.
SO WITH VALIDATION OF THE
SIMULATED B2 FIELDS, IT WORKS
OUT NICELY AS YOU SEE THERE.
I DON'T WANT TO GO TOO MUCH
INTO THE ALGORITHM BUT YOU CAN
SEE THAT THIS WORKS WELL AND
THEY ARE UNIFORM ALONG THE Z
AXIS.
SO LOOKING AT THIS
RECONSTRUCTION, YOU CAN SEE IT
IS DIFFERENT THAN THE
MEASUREMENTS GIVEN TO US BY
THE ORIGINAL ONE.
THE FLOW IN THE VENT CALL IS
MUCH REDUCED AND ALSO THIS
DOESN'T REALLY FIT WITH WHAT
WE HAVE GONE THROUGH.
SO HERE YOU HAVE THE SALINE
AND WHEN YOU LOOK INTO THE
SPACE, THE TERMS WHICH THE
ALGORITHM HAS TO CONNECT
BECAUSE THEY ARE NOT MEASURED
AND SUDDENLY NOT VERY STRONG
SO THAT MAKES THIS VERY STRONG
CURRENT IN THE RECONSTRUCTION.
SO THIS IS NOT A VERY GOOD ONE
BUT YOU CAN SIMULATE THE
MODELS AND THIS IS ACTUALLY
QUITE NICE.
THEY HAVE GOOD CORRESPONDENCE
BETWEEN OUR SIMULATIONS AND
OUR MEASUREMENTS BOTH IN TERMS
OF ABSOLUTE STRENGTH OF THE
CURRENTS OR MAGNETIC FIELD OF
THE CURRENTS --
[INDISCERNIBLE]
WITH THE CURRENTS WE HAVE FROM
LEFT TO RIGHT AND HERE YOU CAN
SEE THE MEASUREMENTS ARE MUCH
MORE WITH IMPROVED SIMULATION.
SO BASICALLY THAT MEANS WITH
THE ACCURACY OF THE SIMULATED
FIELDS AND THE MODEL OF THE
HEAD AS WE HAVE HERE, YOU CAN
SEE WE CAN GET DIFFERENT
MODELS.
SO BASICALLY HERE YOU LOOK AT
THE ELECTRODES, IT IS THINNER
THAN IN THIS CASE SO YOU CAN
TRY TO OPTIMIZE THE
CONNECTIVITY TO SEE IF WE CAN
MAKE THE SIMULATION BETTER TO
THE MEASUREMENT.
SO WHAT WE HAVE HERE IN THIS
ONE EXAMPLE, WE HAVE LESS
CURRENT FLOW AND THEN START
OPTIMIZEING THE VOLUME
CONDUCTOR OF HEAD MODELS,.
[INDISCERNIBLE]
AND THEN ADDING SKULL VOLUME
AND YOU START TO SEE WHEN
OPTIMIZING THE THE
CONDUCTIVITIES, YOU GET THE
CURRENT INDUCED FLOW AND SO
THIS IS WHAT YOU USE FOR SKULL
AND EVERYTHING INSIDE THE HEAD
IS NOT REALLY THE BEST AND YOU
CAN'T OPERATE ON THAT.
WITH MORE SIGNIFICANT
STRAPPING, YOU GET A IMPROVED
MODEL WITH MEASUREMENT AND
THEN EVEN BETTER
CORRESPONDENCE.
JUST TO POINT OUT THEN THIS
HAS A CONSEQUENCE ON WHAT THE
CURRENT LOOKS LIKE, THIS ONE
HERE, THIS IS BASED ON THE
OPTIMIZED CONDUCTIVE --
CONDUCTIVITIES AND WHAT WE SEE
HERE, YOU HAVE THE SINGLE
SLICE MEASUREMENT FROM LEFT TO
RIGHT ON THE SUBJECT AND
PROBABLY TOO THIS CURRENT
INDICES IS GENERALIZED ON THIS
WORK BUT THEN --
[INDISCERNIBLE]
AND THIS IS WHAT WE ARE
WORKING ON AT THE MOMENT.
THEN WE HAVE SLIGHTLY
DIFFERENT SITUATION GIVEN WE
HAVE SEVERAL MEASUREMENTS FROM
FIVE SUBJECTS AND SINGLE MON
AGE, CAN WE FIND ONE SET OF
CONDUCTIVITIES THAT WE HAVE
WITH THE CURRENT INDUCED
MAGNETIC FIELD, YOU HAVE ONE
THAT FITS TO THE GROUP DATA
HERE, YOU SEE THE DATA FOR ONE
SUBJECT WITH IMPROVED CONCEPT
BUT THE CONSEQUENCE WITH THIS
SUBJECT HERE, YOU GET VERY
DIFFERENT MEASUREMENT INSIDE
HERE.
SO THE NEXT THING IS TO
INCLUDE LARGE DATA IN MONTAGES
TO ESTIMATE THE CONDUCTIVITIES
THAT WE CAN USE IN THE GROUP
LEVEL FOR STANDARD
CONDUCTIVITY AND I WOULD LIKE
TO THANK YOU FOR YOUR
ATTENTION AND THANK MY
COWORKERS WORKING ON THIS
TOPIC FOR A LONG TIME.
AND THIS WORK IS SUPPORTED BY
SDC.
THANK YOU.
[APPLAUSE]
>>THANK YOU, WE WILL HAVE TWO
MINUTES FOR QUESTIONS FROM THE
AUDIENCE.
ANY QUESTIONS FROM THE
AUDIENCE?
>>HELLO.
VERY NICE TALK.
I HAVE A QUESTION ON THE
CALCULATION OF THE ELECTRICAL
CURRENT, YOU ASSUME THE XY
PLANE, HOW MUCH DO YOU PLACE
ON ACCURACY, MY FIRST
QUESTION, SECOND THE --
[INDISCERNIBLE]
WHICH IS SLOW SO JUST WANT TO
HEAR YOUR COMMENTS.
THANK YOU.
>>SO OF COURSE WE YOU ARE A
THE VOXELWISE RECONSTRUCTION,
THE FIRST ONE FROM THE XY
ALGORITHMS AND I THINK IT IS
REALLY LOW AND IF YOU USE THIS
TYPE OF ALGORITHM IT WILL WORK
NICE FOR EXTREMITIES THAT ARE
ALONG THAT BUT WHEN YOU HAVE
BRAIN ALGORITHM, IT HAS TOO
MUCH ERROR RATE.
THE ECHO IS SLOW BUT STILL NOW
THERE ARE ITERATES WE CAN GET
AND IT IS ALL ABOUT HOW MUCH
DATA YOU CAN GET OUT OF THE
SLICE.
AND I THINK WITH THREE SLICES
WITH MEASUREMENT OF VERY GOOD
QUALITY, YOU CAN GET QUITE
GOOD LEVELS.
IT IS REALLY DIFFICULT -- I
MEAN OBVIOUSLY WE CAN TALK
ABOUT OTHER METHODS OTHER THAN
SMS BUT THEY COME WITH A VERY
HIGH --
[INDISCERNIBLE]
TO GO TO APPLY SNR AGAINST
THESE HERE.
>>VERY NICE TALK.
I HAVE A QUESTION REGARDING
THE PARAMETER OPTIMIZATION.
SO YOU HAD A NICE DIAGRAM WITH
YOU SHOWED THE SNR WITH A
VARIETY OF TRS AND WITH
CERTAIN TRS, YOU HAD A LOW
SNR.
I HAVE A QUESTION.
DID YOU KEEP THE SAME
COMPARISON ANGLE FOR ALL THE
SLIDES OR DID YOU TRY TO
OPTIMIZE --
>>YES, WE TRIED TO OPTIMIZE
YEAH AND IT STILL LANDS IN THE
SNR RANGE --
[INDISCERNIBLE]
SO THE OPTIMAL DOESN'T LOOK
VERY DIFFERENT THAN WHAT I
SHOWED HERE WITH ANGLES AND
RTE.
>>YOU WEREN'T ABLE TO REDUCE
THE ANGLE BY COMPARING SNR?
[INDISCERNIBLE]
>>SO IF YOU REDUCED THE ANGLE
OF SNR, WERE YOU ABLE TO
SHOW --
[INDISCERNIBLE]
>>WE OPTIMIZED ALL ACROSS THE
COMPLETE RANGE AND THE OPTIMAL
RANGE THEN WAS AROUND 100, 120
MILLISECONDS AND WHEN YOU GO
AWAY FROM THAT, IT IS VERB AS
VERY MUCH AS SHOWN IN THE
GRAPH --
[INDISCERNIBLE]
>>THANK YOU.
[APPLAUSE]
>>SUBJECT SPECIFIC LOW
DENSITY AND FIELDS VERY
RELEVANT IN UNDERSTANDING AND
DESIGNING NEUROMODULATION
TREATMENTS AND ALSO IMPORTANT
IN UNDERSTANDING BETTER WHERE
SOURCES ARE LOCATED IN THE EEG
INVERSE PROBLEM.
THAT SUBJECT REMAINS A LITTLE
OUTSIDE THE SCOPE OF THIS
TALK.
IN THIS CONTEXT, IN
TRANSCRANIAL STIMULATION
CONTEXT, IT IS ALWAYS
IMPORTANT TO MINIMIZE IMAGING
TIME AND BECAUSE IT IS VERY
FATIGUING, IT IS IMPORTANT TO
MINIMIZE THE SUBJECT
DISCOMFORT.
ALSO THE SYNERGY WITH
TREATMENTS FOR TRANSCRANIAL OR
DEEP BRAIN STIMULATION TO SHOW
THE TYPE OF DATA YOU ARE
INTERESTED IN.
IT IS ALSO IMPORTANT HOW WE
CAN USE THE DATA TO MEASURE
MAGNETIC FIELDS.
AS WE KNOW, LOW FREQUENCY
CREATES A MAGNETIC FIELD AND
ONE COMPONENT OF THAT CAN BE
MEASURED IN THE MR PHASE
IMAGES.
WE KNOW BY AMPERE'S LAW THAT
THE CURRENT DENSITY IS
MAGNETIC FLUX DENSITY AND IN
OHM'S LAW, WE KNOW THE
CONDUCTIVITY AND ELECTRIC
FIELD AND WE KNOW ABOVE THE
CURRENT FLOW WE WILL SEE MORE
NEGATIVE VALUES.
AN EXAMPLE OF THE REAL WORD IS
ON THE NEXT SLIDE.
WE HAVE FOUR INJECTION POINTS
AND IN THIS CASE, WE ARE JUST
INJECTING FROM LEFT TO RIGHT
ACROSS THE PHANTOM WHICH
EXISTS OF A GEL BACKGROUND
WITH TISSUE IN THE MIDDLE.
THE MEASURED IMAGE ON THE
LEFT, THE OTHER ON THE RIGHT
AND YOU CAN SEE THE CURRENT
DOESN'T FLOW EXACTLY IN A
STRAIGHT LINE BUT YOU CAN SEE
THE TENDENCY OR POSITIVE VALUE
PHASE TO BE ABOVE THE CURRENT
FLOW LINE AND THE MORE
NEGATIVE VALUE PHASE TO BE
BELOW THE CURRENT LINE.
SO WHAT WE PROPOSE TO DO IS
HAVE NOT ONE BUT TWO CURRENT
FLOWS THROUGH THIS EXAMPLE AND
THEN WE CAN RECONSTRUCT A
UNIQUE CONDUCTIVITY
DISTRIBUTION.
THIS IS WHAT YOU SAW BEFORE
AND WHEN WE RECONSTRUCT THE
CONNECTIVITY, YOU CAN SEE
INSTEAD OF ONE SINGLE PIECE OF
TISSUE IN THE MIDDLE, THERE IS
A DISTINCT GRADE GRADATION
WITHIN THE MASS AND THAT IS
BECAUSE IT INCLUDES SOME
TURKEY MUSCLE AND PORK MUSCLE
IN THE BACKGROUND AND YOU CAN
SEE THAT THE MR IMAGE CANNOT
DO THAT, WITH THE CONDUCTIVITY
IMAGE, IT CAN DO IT VERY WELL.
SO NEXT WE LOOK AT
CONDUCTIVITY CAUSED BY CURRENT
FLOW.
WE BREAK IT OUT IN INDIVIDUAL
COMPONENTS, WE CAN SEE THE
INFORMATION WE COLLECT IS ONLY
PARTIALLY AVAILABLE, IN
PARTICULAR, THE PART
HIGHLIGHTED IN RED.
AS LONG AS THE CURRENT IS
TRANSVERSE, THAT IS IN AN
AXIAL PLANE, ACTUALLY THESE
COMPONENTS THAT WE ARE NOT
ABLE TO MEASURE, THE X & BY
ARE NOT VERY IMPORTANT BUT AS
WE GO OFFLINE, THE MORE
IMPORTANT THEY BECOME.
SO WHAT IS THE BEST EXAMPLE OF
THE CURRENT DENSITY WE CAN
RECOVER USING THIS
INFORMATION?
WELL IT IS TYPICALLY CALLED
THE PROJECTED CURRENT DENSITY
AND WHAT IT IS IS BASICALLY
THE PARTS WE CAN GET TO USING
THIS SINGLE MEASURED
PARAMETER, THE BX.
SO THE DENSITY IS DERIVED
DIRECTLY FROM THE CURRENT
INDUCED FIELD, BZ, IN
COMBINATION WITH THE MODEL YOU
WOULD HAVE IMAGED.
TYPICALLY WHAT ONE WOULD DO IS
MAKE A UNIFORM MODEL WITH THE
SAME GEOMETRY OF THE OBJECT
YOU HAVE FURNISHED AND THEN
HAVE THE MODELING CREATED BY
THE SHAPE AND THEN WE CAN
CALCULATE THE FULL DENSITY BY
COMBINING THE J0 AND B0 IN
GREEN INTO THIS HERE.
YOU NOTICE WE HAVE THE ABILITY
TO CORRECT THE BZ BASED ON THE
CURRENT DENSITY.
THE ERROR DEPENDS ON HOW BIG J
AND BZ IS.
THE CURRENT, WE ARE FOUR
CURRENTS HERE FLOWING AND THE
CURRENT DENSITIES SHOWN IN THE
TWO CENTRAL COLUMNS COMPARED
TO THE CENTRAL SIMULATION ON
THE LEFT.
WE USE A TECHNIQUE CALLED DT
MR EIT.
THE CONDUCTIVITY BETWEEN THE
CONDUCTIVITY STENSOR, C EQUALS
ND AND WE CAN ARRIVE AT THE
RESULT HERE USING TWO
INDEPENDENT INJECTIONS.
SO ON THE RIGHT YOU SEE THE
EXAMPLE OF THE POSITION
DEPENDENT USING DT-MR EIT.
BASICALLY THE FORM OF THESE
RECONSTRUCTIONS ARE VERY
SIMILAR TO THE ONE YOU MIGHT
HAVE SEEN IN THE' EQUATION
FROM THE PREVIOUS SLIDE FOR
THE ALGORITHM BUT NOW INSTEAD
OF USING THE BZ DATA ITSELF,
YOU HAVE THIS FACTOR HERE, D
IN IJ IS THE PSEUDO CURRENT.
HERE IS AN EXAMPLE OF THE
CURRENT IN TWO INDIVIDUALS.
ON THE LEFT YOU CAN SEE THE
DATA, THE MAGNITUDE AND MASKS
USED AND THE BZ DATA COLLECTED
FROM THE TWO INDEPENDENT
ADMINISTRATIONS SHOWING ON THE
RIGHT ALONG WITH THE PROJECTED
CURRENT DENSITY FROM EACH OF
THOSE ADMINISTRATIONS AND
USING THE DT-MR EIT ALGORITHM,
WE'RE ABLE TO PRODUCE THE
SCALING FACTOR FOR EACH OF THE
PARTICIPANTS.
SO YOU SEE THE SCALING FACTOR
HERE ON THE SECOND COLUMN AND
THE INDIVIDUAL COMPONENTS OF
THE CONDUCTIVITY TENSOR ON THE
RIGHT.
WHEN WE COMPARED THE VALUES
THAT WE GOT FROM THE LOW
CONDUCTIVITY OF THE WAY FROM
AND WHITE BRAIN MATTER, WE
FOUND --
[INDISCERNIBLE]
SO NOW WE TALK ABOUT THE USE
OF DATA SETS.
IT IS IMPORTANT TO GET THE
DATA AS QUICKLY AS POSSIBLE,
WHETHER TO MINIMIZE SUBJECT
BURDEN OR COLLECT MORE
AVERAGES.
IN THIS CASE, WE WOULD LIKE TO
EXERCISE SYNERGIES WITH THE
NEUROMODULATION TREATMENT AND
WE ALSO SEE THAT MOST TDCS AND
TACS PROTOCOLS USUALLY INVOLVE
JUST A SINGLE ELECTRODE PAIR
AND MOST OF THOSE INVOLVE
SIGNIFICANT OFFPLANE CURRENT
FLOW.
IF WE JUST ARE ATTEMPTING TO
RECONSTRUCT CONDUCTIVITY FROM
A SINGLE CURRENT
ADMINISTRATION, THIS PRESENTS
PROBLEMS BECAUSE A CURRENT
THAT IS FLOWING PERPENDICULAR
TO A CONDUCTIVITY BOUNDARY
CANNOT SEE THAT BOUNDARY VERY
WELL AND I WILL SHOW YOU SOME
EXAMPLES OF THAT IN A FEW
SLIDES' TIME.
SO THE MEASUREMENT OF COURSE
INCREASES WITH THE AMOUNT OF
OFFPLANE CURRENT
ADMINISTRATION SO WE STILL
CANNOT ESTIMATE THE JZ
DIRECTLY.
SO WHAT APPROACHES HAVE PEOPLE
TAKEN TO REDUCING MEASUREMENT
TIME AND TRYING TO RECONSTRUCT
JUST USING A CANDIDATE MONTAGE
FOR A NEUROMODULATION STUDY?
WELL, ONE APPROACH WE HAVE
USED TO TRY AND REDUCE THE
MEASUREMENT OF TIME IS TAKE
ADVANTAGE OF PARALLEL IMAGING.
SO WE ALREADY HAVE USED A
MULTIFACTOR OF 8 WHICH ALLOWS
US TO CAPTURE THE ENTIRE FRAME
DATA IN SIX MINUTES WITH SIX
AVERAGES THAT IMPROVES GREATLY
ON A PREVIOUS PROTOCOL WE HAD
WHERE IT TOOK US SIX MINUTES
TO GET JUST DATA ON ONE AND A
HALF CENTIMETERS OF THE BRAIN
USING A SIMILAR TECHNIQUE.
AS THE CURRENT INJECTION IS
READILY PERCEIVED AND USING
10HZ, IT IS VERY -- SKIPPING
SPACE LINES, YOU WILL REDUCE
FOLDING AND WHAT WE CAN SEE
HERE IN THE EXAMPLE FROM THE
PAPER, HERE IS AN EXAMPLE OF
ONE OF OUR CURRENT INJECTIONS
IN THE HEAD OF THE PHANTOM, IN
THE OTHER PHANTOM AND HERE IS
THE DATA CREATED FROM THAT
IMAGE USING 2 SKIPPED, TAKING
EVERY SECOND OF LINE K SPACE
AND WHAT WE DID WAS SEGMENT
THAT IMAGE AND REVERSE THE
FOLDING.
YOU CAN STILL SEE A LITTLE
ARTIFACT THERE BUT WE WERE
ABLE TO EASILY RECONSTRUCT THE
CONDUCTIVITY IN THE PHANTOM
AND IN A REAL OBJECT USING
THIS METHOD.
ANOTHER METHOD WE CAME UP WITH
A COUPLE OF YEARS LATER
INVOLVED USING AN ITERATIVE
VERSION OF THE ALGORITHM.
WE COMPARED IT WITH A METHOD I
WILL DESCRIBE IN THE NEXT
SLIDE.
THE TOP HERE, YOU CAN SEE DUAL
LOOP RECONSTRUCTIONS OF
HORIZONTAL AND VERTICAL DATA
AND RECONSTRUCTIONS USING THE
ITERATIVE HBZ ALGORITHM AND ON
THE LEFT, 3 AND 4.
YOU CAN SEE FOR THE HORACE
SANTA WILL FLOW, WE CAN'T SEE
THE VERTICAL EDGES AND ON THE
VERTICAL, WE CAN'T SEE THE
HORIZONTAL EDGES.
THAT IS WHAT I MENTIONED
BEFORE, THAT WE MISS THOSE.
AND HERE YOU CAN SEE THE DATA
USING FULL RECONSTRUCTION AND
HALF THE NUMBER OF AVERAGES.
WE SEE FOR THE VERTICAL
CURRENT FLOW IN THE PROFILE
LINE LOOKS VERY MUCH LIKE THE
VERSION THAT WE SEE FOR THE
FULL RECONSTRUCTION.
SO IT DOES SEEM LIKE A
PROMISING METHOD TO USE TO
RECONSTRUCT SINGLE CURRENTS
BUT STILL IN PLANE.
NOW WE GO TO THE SINGLE
CURRENT DT-MR EIT AND YOU CAN
SEE THIS IS A DUAL LOOP METHOD
BASED ON LEE.
THIS HAS THE SAME UNIT AS THE
ELECTRIC FIELD AND THAT WE DO
HERE IS SET UP TWO
S IMULTANEOUSEQUATIONS BASED
ON TWO LOOPS AND BASICALLY
SAYING THIS QUANTITY, D1J IS
CONSERVED AROUND EACH OF THESE
LOOPS AND WE SAW UNIQUELY FOR
THAT DEFINING THE TWO SETS OF
LOOPS AND ALSO THE ITA.
YOU CAN SEE THAT THE DUAL LOOP
IS VERY STREAKY BUT WE CAN FIX
THAT.
HERE IS THE BASIC INPUT.
WE HAVE A PHANTOM IN GEL.
WE PLACED SOME CHICK MUSCLE
ORIENTED IN THREE DIFFERENT
DIRECTIONS, X, Y AND Z AND
ALSO A ISOTROPIC TISSUE WHICH
IS A PIECE OF POTATO AND HERE
ARE THE FLOWS WITH THE
VERTICAL AND HORIZONTAL AND
THE MAIN DIFFICULT
DIFFUSIVITY OF THE DATA.
SO THAT IS THE PHANTOM
APPROACH.
FOR THE GRNN SETUP, WE HAVE
THE SINGLE CURRENT DT '-MR
EIT, WE RECONSTRUCT THE DATA
IN A DUAL LOOP WITH THE GRNN
AND ULTIMATELY GET THE OUTPUT
THAT WE HOPE IS AN UNSTREAKY
RESULT AND FROM THAT ITA, WE
CAN GET THE CONDUCTIVITY IT
ITA AND FROM THE FORWARD
SIMULATION WE CAN GET THE
ELECTRIC FIELD.
SO THE RESULTS IN THE PHANTOM
LOOK LIKE THIS, YOU SAW THE
FOUR STREAKY DUAL LOOP RESULTS
AND IN THE NETWORK, THEY LOOK
VERY NICE, THEY AGREE WITH
EACH OTHER, VERTICAL AND
HORIZONTAL AND AGREE WELL WITH
THE TWO CURRENT RECONSTRUCTION
USING THE TRADITIONAL
ALGORITHM.
WE ALSO DID THIS IN A HUMAN.
SO SIMILARLY HERE ARE THE
INPUT DATA USED FOR THE
RECONSTRUCTION, THE PROJECTED
DENSITIES FOR THE CURRENT WE
USE, THE SCALING ITA FOR EACH
OF THE CURRENT PROJECTIONS,
THE OZ AND YOU CAN SEE THESE
AGREE VERY WELL WITH EACH
OTHER AND WITH THE SINGLE
CURRENT RECONSTRUCTIONS.
NOW WE HAVE EXTENDED THIS
METHOD TO DEEP LEARNING USING
A UNIT WITH VERY SIMILAR
ARCHITECTURE TO THE GRNN
SETUP.
LOOKING AT THE PHANTOM RESULTS
FOR THE DDL, WHAT WE SEE ARE,
AS BEFORE, THE PROJECTED
CURRENT DENSITY, THE STREAKY
DUAL LOOP RECONSTRUCTION AND
THE CORRECTIONS WE SEE USING
THE DEEP LEARNING ALGORITHM.
AND HERE ARE SOME
RECONSTRUCTIONS SHOWING THREE
COMPONENTS OF THE CONDUCTIVITY
TENS OR IN THE ELECTRIC FIELD.
COMPARISONS WITH THE
INDEPENDENTLY MEASURED DATA
ARE VERY GOOD COMPARED TO THE
TWO CURRENT INJECTION DT-MR
EIT ALGORITHM.
WE ALSO DID THE DL USING THE
HUMAN DATA.
AGAIN, YOU CAN SEE THE
STREAKING DUAL LOOP DATA AND
THE RECONSTRUCTED SCAN AFFECT
HERE COMPARED TO THE
RECONSTRUCTION FIELD ON THE
BOTTOM AND YOU CAN SEE THE
RECONSTRUCTION WE GET FROM THE
DBL.
AND HERE - - D D L.
SO HERE YOU CAN SEE FROM THE
FRONT TO BACK CURRENT
ADMINISTRATION AND COMPARED TO
THE TWO-CURRENT RECONSTRUCTION
CONDUCTIVITY TENSOR ON THE
RIGHT.
AND THERE ARE OTHER APPROACHES
THAT CAN BE USED TO
RECONSTRUCT THE DT-MR EIT.
ONE METHOD THAT CAME OUT LAST
YEAR INVOLVED RECONSTRUCTION
ON THE DT-MR EIT ELEMENTS, WE
COMPARED THIS TO OUR DDL
RECONSTRUCTION AND YOU CAN SEE
FROM THE RESULT, THIS IS THE
RECONSTRUCTION, THE L1 RESULT
IS ON THE SECOND COLUMN.
WE SEE SOME ARTIFACT CREATED
THERE.
IN TERMS OF THE DDL
RECONSTRUCTIONS, HERE IS THE
STREAKING DUAL LOOP AND ON THE
RIGHT, THE OUTPUT WHICH
COMPARES VERY NICELY TO THE
TWO CURRENT REFERENCES FOR
THIS PARTICULAR PROBLEM.
IN CONCLUSION, I HOPE I HAVE
SHOWN IN THIS PRESENTATION
THAT IT IS POSSIBLE TO
RECONSTRUCT STABLE AND--
CONDUCTIVITY FROM A SINGLE
CURRENT DATA AND THAT THESE
METHODS MAY BE USEFUL FOR
MONITORING THE ELECTROMAGNETIC
FIELD DISTRIBUTION AND WE ARE
PRESENTLY TESTING THE DDL
METHOD TO RECONSTRUCT THE
ELECTROMAGNETIC FIELD FOR
DISTRIBUTION OF F3 AND 4 AND
OTHER MODES AS WELL.
SO HERE ARE THE
ACKNOWLEDGEMENTS AND IF YOU
HAVE ANY QUESTIONS ABOUT THE
MATERIAL I HAVE PREPARED,
PLEASE DON'T HESITATE TO
CONTACT ME, MY E-MAIL ADDRESS
IS HERE AND THANK YOU VERY
MUCH FOR YOUR ATTENTION.
>>ALL RIGHT, THANK YOU, Dr.
SADLEIR FOR A VERY INTERESTING
TALK.
SINCE SHE CANNOT ANSWER ANY
QUESTIONS, PLEASE FEEL FREE TO
REACH OUT TO HER BY E-MAIL.
AND WE ARE RIGHT ON TIME TO GO
TO OUR NEXT SPEAKER, Dr.
DANNY WANG FROM UNIVERSITY OF
SOUTHERN CALIFORNIA AND HIS
TALK IS ABOUT MAG AT THE TIME
TICK -- MAGNETIC FIELD
MAPPING.
>>HELLO, EVERYONE, THANK YOU
FOR ATTENDING THIS TALK.
FIRST I WOULD LIKE TO LAY THE
FOUNDATION OF TDCS.
I WILL CONTINUE TALKING USING
TRANSLATION AND FIRST I HAVE
NOTHING TO CONFIRM FOR THIS
PART -- OKAY, SO TDCS, WE KNOW
IT IS NONINVASIVE, LOW COST
AND WITH MINIMAL SIDE TEXTS.
IT HAS POTENTIAL TO ALLEVIATE
SYMPTOMS IN NEURALLIC AND
PSYCHIATRIC DISORDERS AS A
PROMISING THERAPY.
SO I HAVE SHOWN HERE THIS
EXPONENTIAL GROWTH OF THE
PAPERS OVER THE TEN YEARS NOW,
TDCS AND TDCS PLUS MRI.
AND I THINK THE MAIN BARRIER
IS THE INDIVIDUAL BARRIER AS
YOU SEE DIFFERENT RESULTS FROM
STUDIES BASED ON THE
INDIVIDUAL SO I THINK THE HOLY
GRAIL IS TO DO
PERSONALIZED TDCS TREATMENT.
AND TO TRY IMAGING APPROACH
FOR CONCURRENTLY MAPPING THE
ELECTROMAGNETIC FIELDS AS WELL
AS THE NEUROPHYSICAL
PHYSIOLOGICAL APPROACH.
THE PERSONALIZED TDCS
TREATMENT, THE CURRENT HERE IS
VERY LOW AND HE WHAT WE WERE
DOING IS USING THIS SEQUENCE
IMAGE.
THE PHASE HERE USING TDCS-MRI
SETUP TO GET THE ACQUIRED MR
SIGNAL.
TO GET TO THE PHYSICAL
EFFECTS, THE CARRIER IS AROUND
BZ ONLY BUT YOU ALSO GET THE P
-- PHYSIOLO GICAL APPROACH SO
WITH THE TRANSITION OF THE
CURRENT MAPPING, WE BASICALLY
DID -- MANIPULATE THE CURRENT
BASED ON AMPERE'S INDUCED
MAGNETIC FIELD.WHICH IS
PROPORTIONAL TO THE
ELECTROCURRENT AND BECAUSE OF
TDCS, YOU CAN CROSS OUT THE
TIME DEPENDENT FILM AND BASED
ON THE CURRENT ITERATION.
WE DIDN'T TRY TO SOLVE THE
MAGNET TIM FIELD BECAUSE OF
THE COMPLEX ISSUES YOU HAVE
HEARD AND THIS IS OUR
VALIDATION STUDY --
[INDISCERNIBLE]
AND WE HAVE THE WIRE ON THE
CURRENT PATH AND YOU WILL SEE
THIS PATHBE INCREASED WHERE
THE PATH WILL BE DECREASED AND
THIS IS BASED ON SIMULATION
AND THIS IS WHAT WE MEASURED
AND YOU WILL EXPECT TO SEE THE
DISTRIBUTION OF THE MAGNETIC
FIELD WHICH IS THE CASE AND IF
YOU APPLY SHAM, YOU SEE THE
REDUCED FIELD.
IN THE SIMULATION AND ACTIVE
IT IS TRACKING THE FIELD VERY
WELL AND IN THE SHAM, YOU
DON'T SEE MUCH VARIATION AND
JUST LOOKING AT THE
CORRELATION BETWEEN THE
SIMULATION AND ACTIVE AND THE
SHAM MAGNETIC FIELD, BASED ON
THE SIZE OF THE MAGNETIC FIELD
THAT WE MEASURED, WE DON'T
WANT SOME VARIANCE WITH A HIGH
MAGNETIC FIELD BUT EVEN WITH A
POSITIVE AND ACTIVE ONES YOU
STILL GET A VERY NICE
CORRELATION BETWEEN GETTING
THIS SIMULATION AND THE
EXPERIMENTAL MEASURE WHICH
MEANS THE SENSITIVITY IS --
[INDISCERNIBLE]
SO WE DID MAPPING OF THIS TDCS
INDUCED MAGNETIC FIELD, YOU
HAVE VERY NICE MATCHING AND IT
IS MODERATE, ABOVE 0.57, AND
YOU HEARD FROM ANOTHER TALK,
YOU HAVE THE MAGNETIC FIELD
WITH INVIVO OPTIMIZED VALUE.
SO ONE OF THE CAVEATS WE KNOW
ALSO WHEN YOU LOOK AT THE
MAGNET -- MAGNITUDE OF
TDCS-INDUCED BOLD, YOU SEE IT
IS VERY CLOSE TO THE Y.
AWAY FROM THE Y, YOU SEE
ALMOST NOTHING SO BOLD IS ALSO
SENSITIVE TO BOLD AND MAGNETIC
FIELD CLOSE TO Y.
AND I THINK TEN YEARS AGO WITH
A CADAVER IT WAS REPORTED BOLD
SIGNAL CHANGES FROM ELECTRODES
ON THE SCALP.
AND SO ONCE YOU HAVE THE
MAGNITUDE IMAGES, YOU CAN SEE
THE TDCS INDUCED BOLD CHANGES
IN FC AND YOU CAN INTRODUCE IT
IN THE NECESSARY WORK SO YOU
HAVE THE TEST NETWORK AND
FRONTAL AND ALSO THE TEST AND
RETEST VARIABILITY.
YOU WILL NOTICE THERE'S TWO
COMPONENTS ON THE ANODES AND
ELECTRODES AND ESPECIALLY
WHERE THE SIGNAL IS CORRELATED
WITH THE CURRENT.
SO THAT IS OUR FINDING.
ESPECIALLY HEALTHY SUBJECTS,
WE SAW MORE ON THE TEST VERSUS
THE ANODES AND SO ANOTHER
TECHNIQUE, I THINK YESTERDAY
TWO GROUPS PRESENTED THE
LABELING AND INVOLVING
MEASUREMENTS OF TRACER AND
THIS IS WORK DONE BY SEVERAL
DOCTORS, THE ZHENG ET AL GROUP
AND BASICALLY WITH ANODAL
STIMULATION INDUCED17.
1 PERCENT CBF INCREASE AND SO
THIS GROUP IN 2020 DID A LONG
SCAN, BASICALLY 20 MINUTE
ADMINISTRATION AND THIS IS
ANODAL STIMULATION AND THIS IS
THE ELECTRODES AND THE GREEN
LINE IS THE CONTROL LINE SO IF
YOU USE CATHODAL, YOU WILL SEE
VERY SMALL MANIPULATION OF THE
BASELINE AND CONTROL ROI.
SO WITH ALL THIS, WE HAVE THE
BOLD, WE HAVE ASL AND WE CAN
ALSO DO ELECTROMAPPING AND AS
YOU HEARD YESTERDAY, FOR A
VERY PREVALENT DISORDER IN A
SIGNIFICANT PART OF THE
POPULATION AND IN THE
LITERATURE, THERE HAVE BEEN
CONTROVERSIAL FINDINGS IN BOTH
THE POSITIVE AND THE NEGATIVE.
SO IN THIS STUDY BY BR UNONI,
YOU CAN FIND WITH ELECT
TODAY'S WITH TDCS ON THE
PLACEBO AND THEN WE DID A
SMALL STUDY OF MAJOR
DEPRESSION USING THE
TECHNIQUES WE JUST DESCRIBED.
SO THERE IS ACTUALLY THREE
ARMS, THERE IS ABOUT 20 EACH,
X AND YAXIS AND THEN THERE IS
THE PLACEBO SHAM GROUP DIVIDED
IN CONVENTIONAL AND HD AND
THERE ARE 12 TREATMENT
SESSIONS DONE IN TWO WAYS,
RANDOMIZED IN A WAY TO ALLOW
YOU TO DO SEVERAL BLINDS AND
THE TREATMENT FREQUENCY IS TWO
PER 20 MINUTES AND THIS ALLOWS
US TO VERIFY THE ELECTRODE
POSITION AND THE MRI, PRE- AND
POST.
SO THIS IS MONTAGE, THIS IS HD
FOR ANODAL AND SHOULD BE ONE
ANODE AND CONVENTIONAL.
THIS IS THE MI PROTOCOL WITH
SCALP PROJECTION WITH THE DLP
AND WE DETERMINED THE
ELECTRODE PLACEMENT.
THIS IS THE POSITION OF HUMAN
SITE AND PLACED ON THE SCALE.
SO HERE IS THE CONVENTIONAL,
THIS IS THE SHAM SO YOU KNOW
THIS IS MAGNETIC FIELD AND YOU
CAN SEE THE TDCS-INDUCED AND
YOU CAN SEE THE CONVENTIONAL
WHICH IS SWITCHING THROUGH THE
FRONTAL CORTEX AND SO OUR HIGH
SHAM IS BASICALLY NO CHANGE
WHICH IS GOOD.
SO OUR HYPOTHESIS IS REALLY
TWO RANGES, ONE THE ACTIVE
CONVENTIONAL AS YOU SEE AND
THE OTHER IN THE SHAM IN TWO
RANGES.
SO WHEN WE COMPARE THESE THREE
CONDITIONS TOGETHER WITHIN AN
HOUR, WE SAW SIGNIFICANT
CHANGE IN BOTH REGIONS.
BUT IF YOU LOOK MORE
CAREFULLY, THE HD INDUCED
BOLD, YOU SAW THE RELATIONSHIP
TO HD AND THE CONVENTIONAL, A
LITTLE WEAKER THAN HD.
SO BASICALLY WE DID THE BOLD
SIGNAL ANALYSIS AND THERE IS
ONE NODE THAT IS VERY
SIGNIFICANTLY CORRELATED WITH
THE TDCS CURRENT AND ONLY IN
THE HD STIMULATION SESSION, A
CHANGE IN THE CONVENTIONAL AND
THE TDCS ALSO VERIFIED OUR
HYPOTHESIS.
SO IT IS BEAUTIFUL DATA AND WE
ONLY HAVE VERY SMALL AMOUNT OF
CLUSTERS, ONE THE LATTER, THE
OTHER THE HD, AGAIN THE HD IS
THE TREND IN THE CONVENTIONAL
METHOD AND BEAUTIFUL DATA
BECAUSE IN HD, WE ALSO SEE THE
SUBGENITAL ACC INCREASE AND
THIS IS ONLY IN HD SECTION.
SO THIS PAPER WAS PUBLISHED
LAST YEAR.
IN TERMS OF BEHAVIOR, WE
DIDN'T SEE SIGNIFICANT EFFECTS
IN THE SCORES BUT WE DO SEE
THIS EFFECT IN SHAPS.
SO IN BOLD, THERE IS
SIGNIFICANT SHAPS SKULL
CHANGE.
SO YEAH, ANOTHER DIRECTION WE
HAVE BEEN TAKING IS REALLY
TRYING TO UNDERSTAND THE
MECHANISM OF THE TDCS EFFECTS
ON IN VIVO IMAGING AND THIS
PAPER, NOT GOING IN DETAIL BUT
ONE HAS THE BRIEF SLIDE, THE
OTHER A CLINICAL STUDY THAT
WHEN YOU AFFECT THE CURRENT,
YOU APPLY THE CURRENT
POTENTIAL ACROSS EPITHELIAL
CELLS --
[INDISCERNIBLE]
SO THIS STUDY WAS ACTUALLY
PERFORMED BY GRADUATE STUDENTS
AND THE PAIRED DIME WAS WE
USED EXPERIMENT AL PROTOCOL
WITH CONTRAST AGENT AND I WILL
NOT GO INTO THE DETAIL OF THE
SEQUENCE BUT THE PARADIGM WAS
WE HAVE A BASELINE AND THEN 20
MINUTES OF SIMULATION AND UP
TO 20 MINUTES SIMULATION AND
IN THREE SECTIONS, THE 20
MINUTES SHOOTS MORE IN
PREFRONTAL CORD TECHS SO THIS
HAS NOT BEEN PUBLISHED AS WE
ARE STILL DOING ANALYSIS BUT
FIRST LOOKING AT THE
TEST-RETEST BECAUSE EACH
SUBJECT HAS MULTIPLE
MANIPULATIONS AND LOOKING AT
THE WHOLE BRAIN, CBF AND KW,
WE HAVE THE WHOLE BRAIN, THE
SD WAS VERY WELL, THE ICC WAS
MODERATE, .84 AND .64 AND THIS
IS STILL GOING UNDER ANALYSIS.
I AM JUST SHOWING PRELIMINARY
RESULT.
SO WE DID MRI MASKING UNDER
ELECTRODE AND THIS BASICALLY
SHOWS THE RESULTS FROM TWO
MILLION TO FOUR MILLION UNDER
SHAM SO WHAT WE FOUND IS
ACTUALLY ON THE CATHODE, THERE
IS BETWEEN 0 AND 4 DECREASE
BUT NOT UNDER THE ANODE.
THIS IS HEALTHY SUBJECTS WITH
MAINLY THE CATHODES, WE SAW
THE SIGNAL MODULATION BUT NOT
IN THE ANODES SO MAYBE THERE
IS SOME DIFFERENT EFFECTS ON
HOW MUCH YOU CAN REALLY GET ON
EXCITATION OF THE ANODE.
SO TO CONCLUDE, WE SHOW IT IS
FEASIBLE TO CONCURRENTLY MAP
MAGNETIC FIELDS.
WE HAVEN'T GOT MUCH INTO THE
CURRENT MAPPING WE CAN DO BUT
NEVERTHELESS, WE CAN DO THE
BOLD AND CBF AND BBB EXCHANGES
IN VIVO.
AND ON THE SMALL SCALE TRIAL
WITH DEPRESSION, WE SAW
SIGNIFICANT TDCS INDUCED
MAGNETIC FIELD CHANGES FOR
BOTH HD AND CONVENTIONAL
TARGETS AND SO WE ARE GOING TO
DO MORE ANALYSIS ON THE
SIGNIFICANT LONGITUDINAL CBF
SITUATION.
FOR BOTH HD AND CONVENTIONAL
MON TANKS BUT AT ACC FOR TDCS.
IN CLOSING, I WOULD LIKE TO
ACKNOWLEDGE AND THANK THESE
INDIVIDUALS.
THANK YOU.
[APPLAUSE]
>>THANK YOU Dr. WANG FOR A
WONDERFUL TALK.
THANK YOU FOR THE BEAUTIFUL
TALK.
I HAVE A QUESTION ABOUT THE
DEPRESSION TRIAL DATA YOU
REPORTED.
SO IT SEEMS LIKE THE SHAM
GROUP OUTPERFORMED BOTH ACTIVE
GROUPS IN TERMS OF
ANTIDEPRESSANT OUTCOME USING
THE HAMILTON RATING SCALE.
THIS REMINDS ME OF THE
INTERNATIONAL TDCS TRIAL THAT
WAS PUBLISHED BY LU IN 2018
THAT THE SHAM GROUP ALSO
OUTPERFORMED THE ACTIVE USING
BOTH UNILATERAL AND BILATERAL
ELECTRODE PLACEMENT FOR TDCS.
IS THERE SOMETHING IN THE SHAM
MEASUREMENT THAT YOU SAW THAT
WOULD EXPLAIN SUCH AN EFFECT
OR IS IT THAT THE ACTIVE
STIMULATION SOMEHOW IS
DETRIMENTAL TO THE
ANTIDEPRESSANT TREATMENT?
>>WE ACTUALLY I THINK GOT
POSITIVE RESULTS ESPECIALLY
WITH NEUROIMAGINING, WE SAW
POSITIVE CHANGE IN ACTIVE
SIMULATION.
I THINK IF YOU ARE TALKING
ABOUT THE WHATEVER FOR
HAMILTON, IT WAS ACTUALLY IN
THE CONVENTIONAL WORSE THAN
SHAM BUT HD WAS NOT WORSE.
BUT THEN WE DID THE SHAPS AND
SHOWED IMPROVING.
SO YEAH, I THINK OFTEN, THIS
IS TWO WAYS.
THE ONGOING TRIAL, I BELIEVE,
IS FOUR WEEK AND ALSO WE ONLY
DO HD.
SO WITH THE VARIABILITY, THE
QUESTION IS HOW DO WE DEAL
WITH IT BUT WE ARE ONE STEP
CLOSER AND MORE FOCAL BUT HAVE
NOT REALLY REACHED A LAB THAT
IS CUSTOMIZED AND -- [
INDISCERNIBLE ] WE USED THE
METAANALYSIS CARDS FOR THE HD.
SO I THINK THIS IS
IMPROVEMENT.
WE'RE ONE STEP CLOSER AND IT
IS ONGOING.
>>THANK YOU.
FOR THE SAKE OF TIME, WE HAVE
TO MOVE ON TO THE NEXT
SPEAKER, Dr. HAMID --
[INDISCERNIBLE]
, SORRY IF I MISPRONOUNCE, SAY
YOUR NAME WRONG.
AND HE WILL TALK ON
INTEGRATING TES AND F MRI,
POTENTIALS AND CHALLENGES.
>>HELLO, I FIRST LIKE TO
THANK DANNY FOR PUTTING THIS
TOGETHER.
[APPLAUSE]
>> SO FIRST WE WILL TALK
ABOUT WHAT IS TES, COMBINING
TES AND MRI ONLINE AND
OFFLINE, MRI INFORMED TES
TARGET OPTIMIZATION, DOSE
RESPONSE MEASUREMENT IN TE S,
NOISE AND QUALITY CONTROL,
TALK A LITTLE ABOUT THAT AND
ALSO METHODOLOGICAL.
AND SO WE HAVE THE NONINVASIVE
STIMULATION IN THE LAB.
ONE OF THE REASONS I LIKE THIS
TECHNOLOGY, IT IS REALLY
INEXPENSIVE TECHNOLOGY AND IT
IT WORKS, WILL REALLY BE
TRANSFORMATIVE IN PROVIDING
SOMETHING NICE FOR PEOPLE AND
ALSO SOMETHING WE CAN DO AT
HOME.
SO WE CAN HAVE OUR PATIENTS BE
IN THE TRIAL WITHOUT HAVING TO
SEE THEM AND SO THIS IS
PROVIDING SOME EXCITING
POTENTIAL.
BUT WHY COMBINE THE TDCS AND
TES?
SO ONE OF THE SPEAKERS
MENTIONED THE MECHANISTIC
EXPERIMENTS, WE DO MRI BEFORE
AND AFTER AND HAVE DONE OTHER
STUDIES IN TERMS OF HOW TES IS
CHANGING BRAIN CONNECTIVITY OR
HOW WE CAN USE FRMI IN THE
ALARMR SCALE TRIALS.
BUT BEYOND THAT, THERE ARE
SOME POTENTIAL USING FRMI
IMAGING AND THE RESPONSE.
WHEN YOU THINK ABOUT
INTEGRATION OF THESE TWO
TECHNOLOGIES, ONE WAY IS
BASICALLY WHAT WE CALL
OFFLINE, DURING F MRI BEFORE
AND AFTER.
AND THEN THERE IS THE
POTENTIAL FOR ONLINE FMRI SO
WE CAN DO THE FRMI WHILE WE
ARE DOING TES INSIDE THE
SCANNER.
IF YOU ARE ASKING ME ABOUT THE
NUMBER OF MRI IN THESE TWO
TYPE MODALITIES, THIS IS BY
END OF FEBRUARY SO YOU HAVE
JUST SIX MONTHS AND THE
NUMBERS ARE ACTUALLY MORE THAN
THIS BUT YOU HAVE THIS MANY
ONLINE AND THEN OFFLINE YOU
HAVE THIS AMOUNT HERE.
ABLE TO LOOK AT THE TECHNICAL
DETAILS ON THE TRIALS WE HAVE
DONE SO FAR, THE CHALLENGING
PART IS WITH 240 TRIALS IT IS
REALLY LARD TO FIND STUDIES
THAT REPLICATED SOMETHING
ACROSS ALL THE LABS.
REALLY HARD TO FIND TWO
STUDIES THAT HAVE THE SAME
KIND OF PROTOCOL WHICH IS
CONFUSING AND FRUSTRATING SO
WE START TO THINK ABOUT HOW WE
CAN BRING PEOPLE TOGETHER AND
SEE IF WE CAN REPLICATE THAT
IN THE LAB SO HERE ARE THE
PEOPLE WORKING IN TES-F MRI
NETWORK AND WE ARE WORKING ON
PUTTING THEM TOGETHER FOR
COLLABORATIVE PURPOSE.
SO WITH THE FRMI, THERE ARE
SOME POTENTIAL.
FOR EXAMPLE, THIS IS A TRIAL
WE ARE DOING FOR FRONTAL MODE
STIMULATION AND WE START TO
THINK ABOUT GOING THROUGH
NETWORK AND AS YOU CAN SEE IN
THE BRAIN, THERE ARE MANY
PARTS IN THE FRONTAL AND
PARIETAL CORTEX AND REALLY
HARD TO SAY ARE WE TARGETING
THE RIGHT PART.
SO WE BASICALLY EXTENDED THIS
MODELING AND REALIZED THAT
THERE IS THIS IMPORTANT
MEASURE FOR DRUG ADDICTION AND
REALIZED IN THE CONVENTION
MODELS WE HAVE BEEN USING, WE
DON'T HAVE ANY ENGAGEMENT OF
THE SUBPARIETAL NODE.
SO WE START TO LOOK INTO
DETAILS DO WE HAVE ANY
ENGAGEMENT WITH THE DRUG CUE
REACTIVITY.
YES, THERE IS ENGAGEMENT BUT
NOT NECESSARILY THE LOCATION
WE HAVE BEEN LOOKING FOR SO WE
REALIZE WE NEED TO CHANGE THE
MONTAGE AND BASICALLY NEEDED
TO OPTIMIZE THE MONTAGE THAT
WE HAVE AND THIS AND THAT
MONTAGE, WE HAVE THE PARIETAL
NODE ENGAGEMENT.
THEN WE REALIZED BASICALLY WE
HAVE BEEN PUTTING SOME
ELECTRODES ON EACH NODE AND
YOU CAN SEE THERE IS A
VARIATION WITH THE AMOUNT OF
CURRENT WE SEE IN THE
SUBPARIETAL.
BUT IF YOU CHANGED THAT, WE
REALIZED THAT IT WOULD NOT BE
EQUAL.
SO THIS IS HOW PROBABLY THE
MRI INFORM THE FRONTAL AND
SUBPARIETAL AND PUT THAT IN A
PAPER WHERE YOU CAN FIND THAT.
AND THEN THERE WAS THE
QUESTION HOW CAN WE IMPROVE
RESPONSE MEASUREMENT.
IN MRI TDCS, WE SEE THE QUEUE
TASK THERE BUT THERE IS
VARIATION IN THE RESPONSE SO
WE START TO LOOK INTO DETAILS
AND AS YOU CAN SEE, THE
VARIATIONS SO WE TRY TO SEE IF
WE CAN FIND A REASONABLE
RELATIONSHIP BETWEEN THE
RESPONSE AND WHAT WE HAVE IN
ELECTROFIELD MODELING AND
THERE YOU SEE THE RESPONSE OF
THE NEUROMODULATION THEY
RECEIVED AND BASICALLY THE
AMOUNT OF CURRENT WE HAVE TO
THE AREA IS RELATED TO THE
RESPONSE OF MRI.
SO WE EXTENDED THAT TO LARGER
TRIAL WITH PEOPLE WITH THIS
DISORDER AND REALIZED THERE
ARE MULTIPLE LEVELS OF
CONNECTING DOSE TO RESPONSE.
IF YOU CONSIDER THE BOLD TO
THE RESPONSE OF MRI, WE CAN DO
THAT IN THE BOLD LEVEL, THE
ACTIVE CLUSTER, THERE ARE
MULTIPLE VALUES WE CAN
EXPLORE.
IT MIGHT BE INTERESTING THAT
IN THE VOXEL LEVEL, WE HAVE
NOT BEEN ABLE TO FIND ANY
REASONABLE CORRELATION BETWEEN
EF AND MRI ASSOCIATION IN THE
WHOLE BRAIN RESPONSE.
SO THEN WE START TO LOOK ON
THE DOSE AND RESPONSE AND
DON'T WORRY AS WE WILL HAVE
ANOTHER WEBINAR HAPPENING
NOVEMBER 10TH.
SO WE WILL TALK ABOUT THE DOSE
RESPONSE NOT ONLY IN THIS
ORCHESTRATION BUT ALSO OTHER
VALUES AND PROVIDE A FRAMEWORK
ON HOW WE COULD THIS AND ASK
OTHERS TO DO THE SAME LEVEL
ANALYSIS TO MAKE A LEVEL OF
HARMONY INSIDE THE FIELD.
GOING TO ANOTHER LEVEL, THERE
IS THE CONCURRENT ONLINE
TES FMRI AND WE GO THROUGH THE
TECHNICAL DETAILS OF HOW TO DO
THE OUTCOMES.
THERE ARE SOME VALUES MONTAGE
THAT PEOPLE NEED TO CONSIDER.
SO WE LOOK AT THOSE DOING THE
MODEL OF MRI AND AS YOU SEE
HERE, MANY PEOPLE HAVE BEEN
INVOLVED IN THIS STEERING
COMMITTEE.
AND WE TRY TO SEE HOW WE MIGHT
DO IT IN A RIGOROUS WAY SO WE
STARTED TO THINK THAT TO
DESIGN SOME SORT OF CHECKLIST,
IT IS NOT JUST ME AND MY
FRIEND AND THE FRIEND OF MY
FRIEND TO SCORE AND GET
TOGETHER THIS CHECKLIST.
SO WE HAVE BEEN THINKING ABOUT
HOW WE DO THIS IN A
SIMILARATIC WAY AND WE START
TO SEE THE PUBLICATION AND
INVITED THOSE WHO PUBLISH IN
THE FIELD, WE PUT THEM IN
EXPERT PANEL, WE HAVE MULTIPLE
DISCUSSIONS WEBINAR AND TRY TO
COME UP WITH INITIAL VERSION
OF THE CHECKLIST AND THEN ASK
PEOPLE TO RATE THE IMPORTANT
DIFFERENT ITEMS IN THE
CHECKLIST AND ALSO WHAT WE
CALL CONTEST CHECKLIST.
IT HAS A SHORT FORM AND ALSO
HAS A LONG FORM AND IT IS
CALLED CONTES CHECKLIST AND
YOU CAN USE IT FOR EVERY MRI
THAT THE STEERING EMPLOYMENT
SHOULD REPORT.
AND THEN WE WENT THROUGH THE
PUBLICATIONS AND REALIZED MANY
OF THOSE ITEMS ARE REALLY
UNDER REPORTED IN WHAT WE
PUBLISHED BEFORE AND MANY OF
THE ITEMS ARE IMPORTANT IF YOU
WANT TO REPLICATE THE STUDY.
WE NEED THOSE ITEMS TO BE IN
THE STUDY SO YOU ARE BASICALLY
ENCOURAGING THE STEERING
COMMITTEE TO INCLUDE THAT
CHECKLIST WITH THE CURRENT
ITEMS IN THE FIELD.
SO YOU SEE WE HAVE 60 PERCENT
OF CHECK LISTS SO WE HOPE TO
COME BACK IN TEN YEARS AND
HAVE A BETTER RESULT IN TEN
YEARS.
SO WE ESTABLISHED THE PROTOCOL
AND ANNOUNCED THE PACK CAGES
ARE AVAILABLE TO ASSESS THE
STATEMENT.
WE ARE ALSO TRYING TO COME UP
WITH CONSENSUS STATEMENT AND
THESE ARE THE PEOPLE WORKING
TO MAKE THAT HAPPEN.
THEN WE TRY TO SET UP A
QUALITY AND NOISE CONTROL
PROTOCOL AND HOW YOU CAN
COLLECT SOME BASELINE DATA AND
MAKE SURE THAT THE DATA YOU
HAVE, THERE IS NOT SIGNIFICANT
AMOUNT OF NOISE IN YOUR
RECORDING PROCESS.
SO YOU GO THROUGH A SPECIFIC
PROTOCOL AND YOU ARE ASKING
OTHER LABS TO COLLECT ONE SET
OF DATA AND COMPARING THE
RESULT YOU HAVE ACROSS
DIFFERENT LABS.
THIS IS OPEN CALL FOR LABS
INTERESTED TO DO TES AND FDMI
AND DO PUBLISH MULTIPLES, WE
HAVEN'T DONE THAT YET BUT WE
HAVE GROUPS WHO WILL BE PART
OF THE STUDY AND THEN WE HAVE
A NUMBER OF VARIOUS CHANNELS
AND YOU CAN FIND US ON YOUTUBE
OR THE NETWORK.
THEN THE LAST PART WE TALK
ABOUT CLOSING THE LOOP BETWEEN
TES AND FMRI.
IS THERE ANY CHANCE WE CAN
HAVE A LOIN LINE MEASUREMENT
OF FRMI OF THE TARGET
ENGAGEMENT AND LOOK INTO THE
STIMULATION METER AND
BASICALLY CLOSE THE LOOP,
OPTIMIZE THE STIMULATION ON
EACH AVAILABLE LEVEL AND THAT
IS WHAT WE ARE TRYING TO DO
RIGHT NOW.
SO TO BE ABLE TO DO THAT, WE
HAVE TO BE SETTING UP IN MY
LAB THE CLOSED LOOP FOR TE
S FRMI WITH A WATERMELON AND
THERE YOU SEE WE ARE
CONTROLLING FOR THE SIGNAL AND
NOISE AND OTHER THINGS AND YOU
CAN SEE THE WATERMELON AND THE
THING WE PUT IN THE SCANNER,
THE PR WE PUT IN THE SCANNER
AND WE REALIZE THERE ARE
CHALLENGES TO MAKE OUR OWN SET
OF ELECTRODES TO MAKE THINGS
HAPPEN IN TERMS OF HOW TO
CLOSE THE LOOP BUT JUST FEW
DAYS AGO, WE PUBLISHED
TECHNICAL REPORT ON HOW TO DO
THAT AND IF YOU ARE INTERESTED
IN KNOWING THE TECHNICAL
DETAILS OF THIS ONLINE CLOSED
LOOP REALTIME TES FMRI, YOU
CAN VIEW THE TECHNICAL REPORT
THAT IS ONLINE RIGHT NOW.
AND WE HAVE BEEN SUCCESSFUL IN
COLLECTING ONE SET OF PILOT
DATA, 20 ACTIVE PARTICIPANTS
IN TWO GROUPS.
SO BASICALLY WE HAVE BEEN ABLE
TO PUT PEOPLE INSIDE THE
SCANNER, RECORDING AND TRYING
TO OPTIMIZE THE SENSATION
INSIDE THE SCANNER AND AS YOU
CAN SEE HERE, PEOPLE HAVE BEEN
PRETTY MUCH BLINDED IN TERMS
OF THE EFFECT AND MOST
SIGNIFICANT WAS THE SLEEPINESS
IN BOTH GROUPS SO THAT IS
SOMETHING THAT IS TECHNICAL
FEASIBLE BUT WHAT IS THE RIGHT
WINDOW OF STIMULATION AND
RECORDING, SO THERE ARE MANY
TECHNICAL DETAILS THAT WE CAN
DISCUSS.
AND THEN WE HAVE THE
APPLICATION AND DOING THAT
WHILE WE EXPOSE DROP CUES
INSIDE THE SCANNER SO
HOPEFULLY IF WE GET TOGETHER
IN ONE YEAR, I CAN SHOW YOU
THAT SLIDE.
SO NOW WE HAVE THE
INTERNATIONAL NETWORK OF
NEUROMODULATION NEUROIMAGING,
TO PROMOTE COLLABORATION,
DIVERSITY, REPRESENT
SENTIVENESS AND TRANSPARENCY
AND METHODO LOGICAL RIGOR IN
THIS GROUP.
IF YOU ARE INTERESTED, YOU CAN
SCAN THE CODE AND JOIN WHAT WE
HAVE MADE AND THAT IS A WAY
FOR COMMUNICATION.
WE HAVE STARTED TO THINK ABOUT
PUTTING TOGETHER A FEW
SYMPOSIUMS.
YOU KNOW THE TIME HAS CHANGED
THIS YEAR, IT IS GOING TO
HAPPEN IN JULY SO IN TERMS OF
ABSTRACT, WE ARE THINKING OF
PUTTING THE SYMPOSIUM IN THERE
SO IF YOU WANT TO PUT
SOMETHING TOGETHER, YOU ARE
INVITED TO DO THAT AND THEN
DANNY WILL ALSO DO SOMETHING
IN THE HBM GROUP, MAYBE
PUTTING SOME PEOPLE TOGETHER
AND MAKE THAT COLLABORATION
HAPPEN TOGETHER.
SO TAKE A LOOK.
SO WE HAVE THE POTENTIAL
ONLINE AND OFFLINE, HOW PEOPLE
ARE RESPONDING, HOW TO HAVE
DID NOT METHODS, HOW PEOPLE
RESPOND DIFFERENTLY, THE BRAIN
STRUCTURE AND FUNCTION THAT
MATTERS AND ARE FRMI HOW IT
CAN INFORM MONTAGE SELECTION
AND ALSO OPTIMIZE DOSING AND
STANDARDS AND POTENTIAL
MULTISITE COLLABORATION, THANK
YOU VERY MUCH.
>>WE HAVE TIME FOR QUESTIONS.
>>HOW DID THE TES
STIMULATIONS TASTE?
DID THEY TASTE BETTER?
[LAUGHTER]
OKAY, I HAVE A GENERAL
QUESTION, RIGHT.
FOR EXAMPLE CLOSED LOOP IS
FUNCTION MI OR MI IMAGING TO
PROVE THE FACT OF THIS
THERAPY, THE THERAPY STUFF IS
VERY SIMPLE.
IF YOU USE MI, IT IS KIND OF
EXPENSIVE ON PATIENTS SO YOU
USE AN EXPENSIVE CAMERA TO
IMPROVE A VERY SIMPLE THERAPY,
WHAT KIND OF COST OR RETURN ON
INVESTMENT?
ALSO OPTIMIZATION, HOW MUCH
YOU CAN OPTIMIZE.
IF I DON'T HAVE MI AT ALL, I
DON'T HAVE THAT CAMERA, I JUST
GO DO IT, IS THAT GOOD ENOUGH?
THANK YOU.
>>THAT IS A REALLY GOOD
QUESTION.
THAT IS A REALLY GOOD QUESTION
IN TERMS OF COST EFFECTIVENESS
OF USING THAT EXPENSIVE
CAMERA.
AND FIRST OF ALL, I DO NOT
THINK THAT THAT CAMERA IS THAT
EXPENSIVE.
I MEAN YOU MAY FEEL IT IS TOO
EXPENSIVE BUT I MEAN IT IS
NOT -- I MEAN IN THE FIELD, IN
PATIENTS LIKE WHO NEEDLE --
YOU SEE THE PATIENT FOR ONE
SINGLE TIME AND DO NOTHING FOR
THE PATIENT, YOU ARE SPENDING
$2000 A NIGHT.
AND SOMETIMES WE KEEP PATIENTS
IN FOR LIKE 0 60 DAYS.
SO THE COST OF MENTAL HEALTH
ISSUES IS UNBELIEVABLE AND
THERE ARE FAMILIES --
BASICALLY YOU ARE SAVING LIVES
SO IF YOU CAN FIND SOMETHING
TO CONTROL THE LEVEL OF
DEPRESSION, WE ARE BASICALLY
SAVING LIVES.
YOU CANNOT PUT ANY PARTICULAR
PRICE TAG ON THAT.
AND WE ALREADY HAVE ONE
EXAMPLE, ONE GOOD EXAMPLE FOR
FRMI APPLICATION THAT RECEIVED
FDA APPROVAL AND I AM PRETTY
MUCH HOPEFUL THAT WILL BE THE
NEW FUTURE OF NEUROMODULATION
IN TERMS OF OPTIMIZATION
BECAUSE IF YOU DO
NEUROMODULATION EVEN FOR THE
FIRST FEW YEARS, YOU REALIZE
THAT PEOPLE ARE QUITE
DIFFERENT AND WE CANNOT JUST
DO ONE SIZE FITS ALL PROTOCOLS
FOR EVERYBODY AND I AM REALLY
HOPEFUL THAT WILL BE A PART OF
THE CLINICAL PRACTICE OF
NEUROMODULATION AND YEAH, I AM
HOPEFUL TO SEE THAT IN MY
PRACTICE IN THE NEXT 20, 30,
40 YEARS.
THE LOGIC IS GOOD SO
HOPEFULLY, YEAH.
>>THANKS, VERY NICE TO
ORGANIZE THIS COMMUNITY
EFFORT.
FURTHER ON PROTOCOL RELATING
TO YOUR EXPERIMENT, I THINK
THERE ARE A LOT OF STUDIES
USING FENTON, THE KNOWN
CONDUCTIVITY AS IN YOUR TALK
SO I THINK MAYBE YOU CAN
IMPOSE SOME FENTON WITH SOME
CONDUCTIVITY SIGNAL TO NOISE
RATIO, THAT IS MY SUGGESTION.
>>ABSOLUTELY, I AGREE.
THE BEST CASE SCENARIO WOULD
BE HAVING THE TIME TO JUST
TRAVEL TO DIFFERENT LABS AND
MAKE SURE WE ARE USING THE
SAME TYPE OF -- YES,
DEFINITELY SOMETHING TO
STARTIZE THAT DOWN BUT THAT IS
THE STARTING POINT AND YOU
GUYS ARE DOING THAT SORT OF
LEVELS THAT YOU GUYS ARE DOING
ACROSS DIFFERENT LABS.
>> WE THANK THE DOCTOR AGAIN
FOR HIS TALK.
>>THANK YOU.
[APPLAUSE]
>>OUR NEXT SPEAKER WILL BE
ANDREW MITTIGAR.
>>HELLO EVERYONE, I AM ANDREW
MITTIGAR AND -- MINAFAR AND I
WOULD LIKE TO TALK ABOUT THE
MRI NEUROMODULATION OF THE
BRAIN.
FOR MANY DECADES, THERE HAS
BEEN DISCUSSION OF HOW THE
BRAIN IS CLEARED OF WHAT IT
RECEIVES IN AWAKE FUNCTIONS
AND THIS IS AN IMPORTANT PART
BECAUSE THE BRAIN IS AN ACTIVE
FUNCTION.
SO WE LOOKED AT THE GLYMPHATIC
SYSTEM AND IT IS ONLY ACTIVE
DURING SLEEP AND THE REASON IT
IS CALLED GLYMPHATIC SYSTEM IS
IT IS EMPHASIZED BY GLIA.
AND DOCTORS AN ACHIEVEMENT OF
END FEET AND IN BETWEEN THE
END FEET AND VESSEL WALL IS
THIS CONDUIT THAT AIDS IN
FLOW.
AND ANOTHER PHYSICAL LOGICAL
CONNECTION BETWEEN THE TWO IS
CSF FLOW HAS BEEN FOUND TO BE
DEPENDENT ON PULSATILE
CARDIAC CONTRACTIONS SO THERE
IS AN IMPORTANCE BETWEEN BLOOD
FLOW AND PULSATILE FLOW.
WE KNOW THERE ARE A HALLMARK
OF DISORDERS, SPECIFICALLY
CEREBRAL SMALL VESSEL DISEASE
AND POTENTIALLY ALZHEIMER'S
DISEASE.
THE HALL MARK OF THESE AGE
RELATED DISORDERS LEADS TO
DECREASED CSF PER FUSION
PRESSURE AND MORE AND MORE
THERE IS MORE WASTE LEFT
BEHIND EVERY NIGHT WHEN THE
BRAIN IS CLEARED.
AND PART OF THE RESEARCH MY
PROJECT IS TO ADDRESS IS WE
DON'T EXACTLY HAVE MUCH
INFORMATION ON HOW THE
NEUROMODULATION MAY EFFECT
LITTLE STUDIED AREAS AND
SYSTEMS OF THE BRAIN AND ONE
OF THE MAIN ONES I AM LOOKING
AT AND THINK SHOULD BE LOOKED
AT MORE OFTEN IS THE
GLYMPHATIC SYSTEM AND AN
IMPORTANT PART OF THIS IS THAT
WE COULD BE HARMING GLYNPHATIC
FUNCTION WITH THESE ELECTROOR
MAGNETIC SIMULATION
TECHNIQUES.
OBVIOUSLY EVERYONE IS FAMILIAR
WITH THE TRANSVAIN Y'ALL
DIRECT CURRENT STIMULATION
THAT MODULATES PARTS OF THE
BRAIN FOR CORTICO SPINAL
EXCITABILITY.
AND THIS IS VERY SLOW BECAUSE
THEY ARE COUNTING THE TPVS.
SO MY STUDY IDENTIFIED THIS
PVS IN TWO AXIOM AND LOOKED AT
THIS RESPONSE IN A CONTROL
GROUP AND THE HYPOTHESIS OF
THAT WAS DUE TO THE INCREASED
OR DECREASED NEURONAL ACTIVITY
RESULTING IN TDCS, BLOOD FLOW
PATTERNS WOULD CHANGE LEADING
TO CHANGES IN CSF FLOW DURING
PVS AND LEAD TO CHANGES IN THE
BRAIN SUCH AS WHITE MATTER AND
BASAL GANGLIA.
SO I TOOK 12 PATIENTS WHO WERE
SCANNED AND RESCANNED IN ONE
HOUR WITHOUT GOING THROUGH ANY
PROCEDURE OR CHANGE.
IN THE EXPERIMENTAL GROUP,
THERE WERE FIVE PATIENTS OF
SIMILAR AGE AND HEALTH STATUS
WHO ALSO UNDERWENT STRUCTURAL
MRI SCANS USING THE SAME TYPE
OF SCANNER.
BUT THE ONLY DIFFERENCE
BETWEEN THE CONTROL GROUP AND
EXPERIMENTAL GROUP IS PATIENTS
IN THE EXPERIMENTAL GROUP
UNDERWENT 20 MINUTES OF
ANODAL TDCS IN THE PRIMARY
MOTOR CORTEX BETWEEN THE SCAN
AND RESCAN.
SO THE STEPS, ONCE I ACQUIRED
THE PT MRI RATES, I WEIGHTED
THESE USING THE SKIMMER AND
THEN AVERAGED OUT THE NOISE
THAT EXCEEDED A GIVEN
THRESHOLD AND THEN ONE OF THE
NOVEL TECHNIQUES DEVELOPED
RECENTLY BY Dr. SEPERBAN AT
U.S.C. INSTITUTE IS BY
DIVIDING A THIRD IMAGE AND YOU
CAN SEE THE THIRD IMAGE KNOWN
AS THE ENHANCED PVS CONTRAST
IMAGE OR EPC CONTAINED MORE
CONTRAST AND WAS FOUND TO BE
MORE ACCURATE IN FORMULATING
THE PARADIGM IN THOSE IMAGES.
SO I LOOKED AT THE WHITE
MATTER AND PACE SALARY GANGLIA
MASKS OF THE EPC IMAGES AND
THE FRANGI FILTERERRING TO
DETERMINE PVS LOCATIONS.
THEN I CAME UP WITH A
COMPUTATION AND COMPARISON OF
PVS VOLUMES USING QUANTITATIVE
IMAGING TOOLKIT.
YOU CAN SEE THERE WAS NO
SIGNIFICANT CHANGE IN THE PVS
VOLUME AND ALSO A TREND IN THE
TOTAL WHITE MATTER VOLUME
WHICH DID NOT CHANGE WITHIN
THE TWO GROUPS.
BUT LOOKING AT THE PVS TEST,
YOU CAN SEE THE PVS VOLUME IN
BASE SALARY GANGLIA IS GREATER
AND THAT MEANS THEY NOT ONLY
HAVE A TOTAL GREATER VOLUME
BUT NOT LINKED TO HAVING
GREATER PVS IN THE BASE SALARY
GANGLIA SO IT MUST HAVE THIS
ON ITS OWN.
THEN I USED THIS ON THE DIES
COEFFICIENT OF PVS MASKS AND
WITHIN THE TWO CONTROL GROUPS,
IT WAS BASICALLY THE SAME BUT
IN THE BASAL GANGLIA, THE PVS
MASKS WERE MUCH LESS SIMILAR
TO THE CONTROL GROUP AND
LASTLY I USED IMAGE J TO SEE
HOW DILATED THE PVS WERE TO
SCAN AND RESCAN IN BOTH GROUPS
AND I FOUND OUT THAT THE
AVERAGE DILATION BETWEEN PVS
AND WHITE MATTER WAS NOT
SIGNIFICANTLY DIFFERENT BUT IN
THE PVS GROUP, THERE WAS A
DILATION COMPARED TO THE
CONTROL GROUP.
WHAT DOES THIS MEAN?
THIS IS A POTENTIAL LINK
BETWEEN TDCS AND BASAL GANGIA
MORBIDOLOGY PROOF.
THIS COULD BE A DISCUSSION
THAT THE INDUCED SIGNIFICANT
CHANGES IN THE PVS AND PVS,
THAT MIGHT BE A FUTURE
DIRECTION TO PURSUE BUT THIS
IS THE FIRST CONCLUSION AND
WILL BE INTERESTING RESEARCH
IN FUTURE DIRECTIONS TO SEE IF
THIS IMPROVES IN OTHER AREAS
AND CLOSER TO THE SITE OF
ADMINISTRATION.
SO WITH THAT I WOULD LIKE TO
ACKNOWLEDGE MY MENTORS FOR
DEVELOPING MUCH OF THE
PROTOCOL FOR THE RESEARCH AND
ALSO SIMONE VE ALE AND OTHER
RAS FOR AIDING ME IN
CONDUCTING THIS RESEARCH.
>>WE ARE A LITTLE OVER TIME
SO LET'S MOVE TO OUR LAST TALK
FROM Dr. VACA.
>>HELLO EVERYONE, TODAY I
WILL TALK TO YOU ABOUT THE
MODULATION EFFECTS OF THE
TRANSCRANIAL DIRECT CURRENT
STIMULATION ON THE DORSAL
ATTENTION AND FRONTAL PARIETAL
NETWORKS AND ASSOCIATION WITH
THE PLACEBO EFFECT.
I HAVE NOTHING TO DECLARE AND
NOW WE ARE STUDYING HOW TO
INVESTIGATE HOW I THE
MULTISESSION TRAPS VAIN Y'ALL
DIRECT CURRENT STIMULATION ARE
DESIGNED AND HOW THE FUNCTION
OF CONNECTIVITY CHANGE MAY BE
MANIPULATED WITH THE PLACEBO
AND OTHER EFFECTS.
THE PLACEBO ANA LGESIA EFFECT,
RECENTLY BRAIN IMAGING HAS
BEEN WIDELY USED TO EXPLORE
THE PLACEBO AND NOCEBO
EFFECTS.
HOWEVER MOST OF THE CURRENT
STUDIES HAVE APPLIED
OBJECTIONIZATIONAL METHOD AND
SO WE WANT TO EXPLORE HOW
EXCITABILITY AND CONNECTIVITY
CHANGES OF CERTAIN BRAIN
REGISTER COULD MODULATE THE
PLACEBO AND NOCELO EFFECTS.
SO WE HAVE HEALTHY SUBJECTS
AND THEY WERE HAVING TDCS
APPLIED 20 MINUTES FOR THREE
CONSECUTIVE DAYS.
THEN THERE WAS A RESTING STATE
WHERE WE DID NOT HAVE ANY
SCANS FOR THAT DAY.
SO WE THEN MESH THE PLACEBO
AND NOCEBO EFFECTS.
AND ASSESSING FOR THE SUBJECT
BETWEEN EXPECTANCY AND
PLACEBO/NOWEBO AND HOW THEY
WOULD BE DIFFERENT.
AND THEN WE APPLIED THE SAME
MODEL IN TERMS OF EACH PAIN TO
LOOK AT THE SPECIFIC RESPONSE.
SO WE HAVE THIS HERE --
[INDISCERNIBLE]
WE LOOK AT THE FINAL TREATMENT
ON DAY 3 AND THE TDCS ON
PREDAY 1.
AND WE FOUND THAT THERE WAS
SOME REACTION WITH THE PLACEBO
EFFECT.
STATISTICAL ANALYSIS, OUR WORK
WHICH YOU CAN FIND AT THE
BOTTOM OF THIS SLIDE IS
COMPARED TO SHAM TDCS AND
CAN'T HODAL TDCS,
SIGNIFICANTLY BOOSTED WITH
PLACEBO ANA LGESIA AND --
[INDISCERNIBLE]
AND YOU CAN SEE IN THE LEFT
THERE IS THE CORRELATION MASKS
WHITE ON THE RIGHT, YOU HAVE
OUR NETWORK THAT YOU SEE IN
GREEN AND IN THE PINK.
THIS IS WHERE WE CAN SEE THE
FUNCTION OF THE SUBPARIETAL
EFFECT OF THE NETWORK, THE
ANODAL SHAM AND THE CATHODAL
SHAM.
AND SO AT THIS POINT WE
EXTRACT THE SET OF VALUES FROM
EACH OF THESE PROCESS AND DO
THE CORRELATION AND WE
ACTUALLY FOUND THAT THE PLAQUE
FOUND IN THE NETWORK IN
COMPARISON TO THE CATHODAL.
AND NOT JUST IN THE NAME OF
TDCS BUT ALSO THE IMPULSE 3 --
[INDISCERNIBLE]
SO AFTER THE DISCUSSION, NOT
ONLY THE NETWORK BUT ALSO
PRE-DAY 1, THE NETWORK WAS
INVOLVED IN SEVERAL DIFFERENT
CONSTRUCTION.
BOTH RECONNECT APPEARS TO BE
INVOLVED IN THE PROCESSING OF
THE SENSORY A MOTOR STIMULI
SUCH AS PAIN.
SO WE ALSO FOUND THE OPERCULUM
PLAYS A PIVOTAL ROLE IN
EXPERIMENTAL PAIN PERCEPTION
AND THAT TDCS MAY MODULATE THE
FUNCTIONAL CONNECTIVITY IN THE
NETWORK AND IN PARTICULAR, MAY
MODULATE THE FUNCTIONAL
CONNECTIVITY BETWEEN THE RIGHT
OPERCULUM AND TDCS.
SO ALSO THERE IS A CORRELATION
THAT SHOWED THE INBOUND CREASE
BETWEEN TDCS AND THE RIGHT
OPERCULUM AND CORRELATED TO
PLACEBEEN O ANA LGESIA
EFFECTS.
I WOULD LIKE TO THANK THOSE
WHO HELPED ME AND THANK YOU
FOR YOUR ATTENTION.
[APPLAUSE]
>>WE'RE ACTUALLY OVER TIME SO
MAYBE WE CAN HAVE ONE
QUESTION.
ANY QUESTION FROM THE
AUDIENCE?
NO?
WE WILL HAVE A SHORT
SPEECH FROM THE DIRECTOR OF
NIDA
>>HELLO, EVERYONE, IT IS A
PLEASURE FOR ME TO BE GIVING
SOME REMARKS AT THE NIH
INTERNATIONAL SOCIETY AND IT
IS VERY EXCITING TIME TO BE
LOOKING AT NEUROMODULATION
TECHNIQUES AND BRAIN
STIMULATION WHICH HAS BECOME
VERY IMPORTANT TO THE STUDY OF
BRAIN FUNCTIONS AND ALSO HAVE
SHOWN THE POTENTIAL FOR SOME
DISEASES AND RESEARCH IS GOING
ON TO ACTUALLY DOCUMENT HOW WE
CAN USE THIS APPLICATION FOR
DISORDERS AND FOR TREATMENT.
ALSO IT ALLOWS US TO USE
MAGNETIC RESONANCE FOR
NEUROSTIMULATION AND THIS IS
AN AMAZING TOOL BECAUSE IT
ALLOWS US TO LOOK IN VIVO HOW
THE BRAIN IS AFFECTED BY THIS
AND HOW TO MANAGE THE DOSE IN
TERMS OF INTENSITY AND
FREQUENCY AND HOW MUCH
VIABILITY THERE MAY BE IN VIVO
WHILE AT THE SAME TIME
UNDERSTANDING HOW THESE
NEUROLOGICAL CHANGES HAPPEN IN
THE BODY AND GIVE DIFFERENT
RESPONSES.
SO THE TOPIC OF THIS
CONVENTION IS PERFECT AND IN
LINE WITH THE GOALS OF THE
NATIONAL INSTITUTES OF HEALTH
ON CUTTING EDGE TOOLS TO
UNDERSTAND BRAIN FUNCTION.
THIS WILL BRING TOGETHER A
VERY GOOD GROUP OF SCIENTISTS
AND ALSO DEVELOPERS ON
TECHNIQUES ON MRI AND
NEUROMODULATION ON THE BRAIN.
WE EXPECT THIS WILL HAVE AN
IMPACT ON RESEARCH TO PUT IN
PRACTICE.
AND WE ALSO HOPE THAT THIS
WORKSHOP WILL FURTHER
DISCUSSION AND PARTNERSHIP AND
NETWORKING OPPORTUNITIES AND
ACCELERATE RESEARCH INTO THE
FUTURE.
THIS WORKSHOP IS BY Dr. WANG
OF CALIFORNIA AND Dr. YANG
FROM THE NATIONAL INSTITUTE ON
DRUG ABUSE AND SPONSORED BY
THE NIH AND SOCIETY FOR
MAGNETIC RESONANCE.
AND AGAIN THE PURPOSE OF THIS
WORKSHOP IS TO PROMOTE
COLLABORATIVE RESEARCH BETWEEN
INTRAMURAL INVESTIGATORS AND
EXTERNAL SCIENTISTS AND AS
ALWAYS, TO COME UP WITH NEW
IDEAS AND POTENTIAL FOR
TRANSLATION OF SOME OF THESE
TOOLS AND TECHNOLOGIES INTO
POTENTIAL TOOLS FOR THERAPIES.
SO I LOOK FORWARD TO HEARING
THE GOALS WE WOULD LIKE TO
ACHIEVE AND SUGGESTIONS AT THE
END OF THE MEETING SO THANKS
VERY MUCH FOR YOUR ATTENDANCE
AND PARTICIPATION.
[APPLAUSE]
>>THANK YOU AND AFTER THREE
YEARS OF ZOOM CALLS, I AM
GETTING USED TO THIS ALSO FROM
MY CHAIR.
WELCOME TO THE CONVENTION ON
NEUROMODULATION ON MRI AND THE
FIRST PRESENTATION WILL BE
GIVEN BY ALEXANDER FROM
UNIVERSITY OF TORONTO AND THE
TALK IS ABOUT --
[INDISCERNIBLE]
SO THE STAGE IS YOURS.
>>THANK YOU FOR.
>>NOTE ALEXANDRE BOUTET,
STIMULATION AND PARKINSON'S
DISEASE.
>>HELLO, I HAVE NO FINANCIAL
INTERESTS TO DECLARE AND HERE
ARE A FEW ABBREVIATIONS FOR MY
TALK.
SO I DECIDE TO ADD THIS SLIDE
BECAUSE I AM THE FIRST TO TALK
ABOUT D BS.
SO PEOPLE KNOW WHAT D BS LOOKS
LIKE, IT IS LIKE A BRAIN
PACEMAKER THAT IS PLACED IN
THE BRAIN AND THERE IS A
BATTERY OR ELECTRODE CONNECTED
BY AN EXTENSION WIRE.
AND IF YOU LOOK AT THE
INTRODUCTION, YOU CAN SEE IT
STARTED IN THE 1990S FOR
PARKINSON'S DISEASE AND
INCLUDES A NUMBER OF TARGET
DEVICES BY FDA AND IT ALLOWS
US TO DELIVER IN A STANDARD
WAY NEUROMODULATION.
IF YOU LOOK AT THE TRIALS, YOU
CAN SEE IN THE LAST 15 YEARS
IT IS GROWING MAINLY DUE TO
ALZHEIMER'S AND PSYCHIATRIC
DISORDERS AND 15 PERCENT OF
THOSE TRIALS ARE LOOKING AT
NEUROIMAGING AS A PRIMARY
COULD YOU TELL I DON'T WANT.
SO THE MOST POPULAR ANALYSIS
RIGHT NOW IN THE FIELD IS
LOOKING AT ELECTRODE POSITION
AND GENERATING THE VOLUME OF
TISSUE ACTIVATED AND THESE
CAN SET A NORMATIVE CONNECTION
AND ALLOW IN RECEIVE VIS
FUNCTIONAL MAGNETIC RESONANCE
IMAGING.
BUT TODAY, I WILL NOT BE
TALKING ABOUT THIS, I WILL
TALK ABOUT SOMETHING WE HAVE
BEEN DOING IN THE FIELD ON S
MRIS WHERE SEPARATORS A FULLY
ENACTED D BS IN THEIR BRAIN.
SO AS MOST OF YOU KNOW, S MRI,
OFTEN DONE WITH BOLD CONTRAST
AND MEASURES BRAIN ACTIVITY
AND MAPS THE BRAIN WITH WARM
AND COOL COLORS.
AS WE LOOK AT THE NUMBER OF
PICKUP PUBLICATIONS THAT ARE
DOING THIS SO CALLED IN VIVO
RESEARCH, IT IS MOSTLY IN THE
LAST FIVE TO SEVEN YEARS THAT
WE SEE THIS HAPPENING AND NOW
WE UNDERSTAND BETTER HOW TO
SCAN PATIENTS WITH F MRI.
SO AS WE LOOK AT THE BREAKDOWN
WHAT MOST PEOPLE HAVE STUDIED,
IT IS MOSTLY PARKINSON'S
DISEASE BUT THERE ARE A NUMBER
OF SUBJECTS YOU CAN STUDY WITH
F MRI FROM AGING DISORDERS TO
CHRONIC HEALTH OF THE BRAIN.
SO WE LOOK AT THE BREAKDOWN OF
DBV IN VIVO FOR F MRI, THE
PROGRAMMING, TECHNICAL
CHALLENGES OF TO GO THIS AND
OTHER D BS INDICATIONS.
SO WHAT ARE SOME OF THE THINGS
WE SEE?
SOME OF THE EARLIEST STUDIES
IN 2001, YOU CAN SEE ALL
PATIENTS WERE SCANNED WITH A F
MRI AND THE D BS WAS TURNED ON
AND YOU CAN SEE THE BLOCKS OF
COLOR ARE BOLDLY REPRESENTED
IN THE BASAL GANGLIA ON THE
LEFT AND THE RIGHT SIDE.
NOW, THERE WAS A STUDY ONE OR
TWO YEARS LATER THAT WAS VERY
INTERESTING WITH ONE PATIENT,
HIS RIGHT VENT CALL ELECTRODE
WAS NOT GIVING MUCH RESPONSE
AND THE LEFT ELECTRODE WAS
GIVING MOST BENEFIT.
SO YOU CAN SEE WHEN TURNED ON,
IT FEATURED BOLD CHANGES IN
THE MOTOR AREA.
WHEREAS THE RIGHT ELECTRODE
SHOWED DEPRESSIVE SYMPTOMS IN
NONMOTOR AREAS.
SO YOU CAN SEE AS A RESULT
WITH PARKINSON'S AND LEVODOPA,
THEY BOTH REQUIRED DIFFERENT
TESTS.
SO THIS WAS THE RESULT OF D BS
VERSUS LEVODOPA AND YOU ARE
GIVEN THE CHANGES WITH D BS IN
TREATMENT.
SO WE SORT OF OVERLAPPED THE
AREAS WITH INVESTIGATIVE
REPORTS AND YOU CAN SEE NOT
SURPRISINGLY, MOST OF THE
AREAS ARE MOTOR-RELATED AREAS
INCLUDING CEREBELLUM AND MOTOR
CORTEX.
SO WE DID THIS STUDY A FEW
YEARS BEFORE THAT LOOKS AT HOW
THE BRAIN CHANGES WITH D BS
TURNED ON AND OFF AND NOT
SURPRISINGLY, THERE IS A SORT
OF SIMILAR PATTERN WITH DEEP
STRUCTURE IN NONMOTOR
ACTIVITY.
SO WHAT HAPPENS TO THE BRAIN
OVER TIME, WE PERFORM D BS AT
TIME ZERO AND THEN EXAMINE THE
PATIENT A NUMB OF YEARS LATER
AND THE ACTIVITY IS ACTUALLY
QUITE DIFFERENT.
SO CLEARLY HERE WHILE I AM
TALKING ABOUT THE ACUTE CHANGE
WITH MRI, THERE IS DEFINITELY
A VALUE IN TRYING TO PERFORM
IT OVER TIME TO TRY TO
UNDERSTAND WHAT HAPPENED IN
TERMS OF' LASSIVITY IN THE
BRAIN OF THOSE PATIENTS OVER
TIME AS IDENTIFIED BY THE
STN-D BS STUDIES.
AND ONE OF THE THINGS WE
LOOKED AT WITH THE MRI IS CAN
WE AT LEAST HAVE THE SAME BOLD
PATTERN IN THE SAME PATIENT 30
MINUTES APART.
SO THIS WAS AN EXAMPLE OF ONE
PATIENT WE HAD WHERE WE
SCANNED, WADE 30 MINUTES AND
THEN RESCAN AND THIS TOLD US
WHAT WE ARE ACQUIRING IS
REPRODUCIBLE AND NOT JUST SOME
ARTIFACT OF THE D BS IN F MRI.
SO NOW WE FOCUS ON HOW CAN WE
USE D BS PROGRAMMING.
IT IS THAT PROCESS AFTER
SURGERY WHERE WE EXECUTE A
TAILORING FOR THE INDIVIDUAL
PATIENT.
THE GOAL IS TO MAXIMIZE
BENEFIT WHILE MINIMIZING
ADVERSE EFFECTS.
AND THIS IS DONE AT THE
CLINICIAN'S OFFICE.
IN THE TERMS OF PARKINSON'S
DISEASE, IT MAY TAKE UP TO TEN
WEEKS WITH EACH SESSION AN
HOUR OR TWO HOURS LONG AND SO
YOU CAN SEE THERE IS A LOT OF
TIME FOR EACH OF THESE
PATIENTS WHO ARE ARE FRAIL AND
NOT VERY MOBILE AND IT IS ALSO
COSTLY FOR THE MEDICAL SYSTEM.
SO THE IDEA HERE IS CAN WE
TAKE THIS CLINICAL AND
PROGRAMMING MECHANISM AND TEST
AGAINST EXPOSURE TO THE
RESPONSE AND THE 'EM DATA
SHOWS WE CAN USE OBJECTIVE
MARKER OF RESPONSE TO D BS.
YOU WILL HEAR MORE OF THIS IN
THE NEXT TALK BUT POTENTIALLY
SPEAKING, THERE ARE STRICT
GUIDELINES FOR D BS PATIENTS
OF 1.5 OR 3 TENS AND A LIMITED
AMOUNT OF ENERGY IS USED TORE
SCANNING.
AND WHAT IS CONFUSING IS EACH
VENDOR HAS SLIGHTLY DIFFERENT
GUIDELINES SO IF YOU DO THIS
IN PATIENTS, YOU HAVE TO BE
AWARE OF WHAT IS IN THE MODEL
THAT THE PATIENTS HAVE IN
TERMS OF D BS.
AND AS I WAS SAYING EARLIER,
THE GUIDELINES LAPSE IN WHAT
WE CAN DO WITH EACH OF THESE
PATIENTS AND IT IS ONLY
RECENTLY WE HAVE SELECTED D BS
MODELS MAKING ELIGIBLE FOR 3T
FOR PATIENTS.
THE IDEA WAS TO MINIMIZE THE
RISK AND IMPROVE THE OUTCOME
FOR PATIENTS WHO UNDERGO THE
SCANNING AND THESE WERE SOME
OF THE EARLIER TOOLS WE USED,
PROVIDING PATIENTS WITH D BS
AND MEASURE THE HEATING AT THE
TIP OF THE ELECTRODE WHICH IS
ALWAYS THE MAIN RISK WHEN
SCANNING THESE PATIENTS.
NOW, A LOT OF YOU ARE THINKING
HOW DO YOU DO THE MRI SEQUENCE
WITH METAL IN THE HEAD AS THE
BRAIN IS PARTICULARLY
SENSITIVE TO THESE METAL
ARTIFACTS.
SO THEY ARE ABOUT .1 IN VOLUME
AND WHILE IT IS NOT
ACCEPTABLE, IT IS NOT
PROHIBITIVE ACCOUNTING FOR A
SMALL NUMBER OF ARTIFACTS.
SO THIS IS HOW WE DID THE
EXPERIMENT.
ON THE LEFT SIDE YOU CAN SEE
THE SELECTION FOR PARKINSON'S
AND ON THE RIGHT, ALLOWS US TO
MAKE CONTACT AND DELIVER
ELECTROMAGNETIC FREQUENCY AND
THE ON THE TOP SIDE, YOU SEE
THE RECOMMENDED TODAY'S
IMPLANTED IN A PATIENT WITH
ALZHEIMER'S DISEASE.
THEN THE ACTIVITY WAS TURN ON
AND OFF EVERY 30 MINUTES FOR
SIX AND A HALF MINUTES AND WE
DID THIS FOR EVERY PATIENT.
THE KEY HERE IS THESE PATIENTS
WERE A YEAR OUT OF SURGERY SO
WE KNEW BEFOREHAND WHAT IS THE
OPTIMAL OUTCOME AND CLINICAL
OUTCOME.
SO WE HAD A TOTAL OF 203
SESSIONS AND THE OTHER POINT
HERE IS WE USED THE LEFT ONLY
BECAUSE WE WANTED TO SEE THE
RIGHT SIDE OF THE BRAIN AS
CONTROL AND ALSO BECAUSE THE
EXTENSION WIRES ON THE RIGHT
SIDE OF THE HEAD.
SO THE F MRI STEP WE TOOK,
REGULAR MOTION CORRECTION,
NORMALIZATION OF THE DATA IN
EXTRACTING THE STATS.
AND THEN TO BUILD THE MODEL,
WE FOUND 16 ROIS WHICH WE
LOOKED AT TO FIND THE AREA
WITH THE MOST BENEFIT.
SO WITH SINGLE SUBJECT
ANALYSIS, WE LOOKED AGAIN AT
THE 16 ROIS.
THEN WE STARTED WITH A SIMPLE
MACHINE MANNERRING ANALYSIS
AND THEN WE FED IN THE TEST
DATA TO VALIDATE ITS MODELS.
SO HERE YOU CAN SEE ONE
PATIENT IN A AND ONE PATIENT
IN B WITH LEFT UNILATERAL
STIMULATION AND YOU CAN SEE
HERE THE MOST CHANGE IN THE
CORTEX AND AS YOU MOVED AWAY
FROM THAT, IT IS THE MIDDLE
PATTERN AND ARE ON THE RIGHT,
IT SHOWS MINIMUM ON THE RIGHT.
HIGH VOLTAGE IN THE BOTTOM
ROW, YOU SEE USING THE
STEREOTYPICAL PATIENT IT IS
HIGHER BUT SPILLS OVER IN
OTHER AREAS SO WHEN WE LOOKED
AT THIS, WE THOUGHT WE CAN
PROBABLY FIND OUT WHICH
PATTERN IS OPTIMAL BASED ON
THOSE THREE MAIN AREAS SO THIS
SUGGESTS TO US WE CAN TELL
FROM THE PATTERN WHAT IS THE
UPMODE OF PATTERN FOR EACH
PARTICULAR PATIENT.
AND WHEN WE DID THIS, WE CAME
UP WITH 88 PERCENT ACT AND
VOLTAGE DATA AND THE NORMAL AT
39.
THAT IS DATA SET 1.
THEN WHEN WE USED OUR
STIMULATION NAIVE, IT WAS DATA
SET 2.
THEY WERE SIX MONTHS AFTER
SURGERY PRIOR TO THEM GOING
INTO A NEUROLOGIST'S OFFICE.
SO WE HAD OUR MRI AND THEN
WHAT WOULD BE THEIR OPTIMAL
AMOUNT.
SO THE PATTERN PREDICTED TEN
MONTHS AHEAD OF TIME SHOWING
WHAT WE DO WITH A PATIENT NINE
MONTHS AFTER SURGERY.
AS FAR AS THE CLINICAL TRIAL,
YOU HAVE A PATIENT WHO IS OUT
OF SURGERY, THE MR I, THE
PATIENT GOES IN THE FIRST
CONTACT WITH THE HOPE WE WILL
IMPROVE CLINICAL OUTCOMES,
DECREASE THE TIME AND
THEREFORE SAVE MONEYFUL AND
WOO ON WILL WE'RE ALSO
LOOKING AT THE F MRI AND AS
FAR AS A MODEL, IT IS MORE
PROMISING AND MUCH MORE
FLEXIBLE AS YOU CAN SEE HERE.
NOW IF YOU ASK ABOUT OTHER
IMPLICATIONS, THE MAIN REASON
WE USE THIS IS THE NUMBER AT
FIRST.
THERE ARE JUST SO MANY MORE OF
THOSE PATIENTS, IT IS EASIER
TO DO THAT EXPERIMENT.
AND ALSO WHEN YOU TURN ON THE
D BS INDICATIONS LIKE FOR
PARKINSON'S, THERE IS AN
IMMEDIATE IMPACT.
BUT MOST OF THE INDICATIONS
SUCH AS ESTONIA, PSYCHIATRIC
DISORDER SORE DEPRESSION,
THERE IS NO FEEDBACK.
SO YOU CAN IMAGINE THIS IS
EVEN MORE MYSTERIOUS AND
INDIVIDUALLY BASED.
WE DID THIS WITH 17 PATIENTS,
DIFFERENT CIRCUITS, THE FIRST
THING WE NOTED WITH THE MRI IS
THE CHANGE WAS NOT
MOTOR-RELATED.
SO A VERY GOOD PROBABILITY
THAT --
[INDISCERNIBLE]
AND THE MAIN WERE THE DORSAL
ANTERIOR CINGULATE CORTEX.
WE TRIED TO USE THOSE PATTERNS
IN THE THREE AREAS FOR
SUBCALLOSAL CINGULATE AND YOU
SEE HERE THE IMMEDIATE PATTERN
WE HAVE ON THE F MRI PREDICTS
THE BEHAVIOR OF A WEAK SPACE
AND THIS MAINTAINS A SMALL
SAMPLE.
WE DID A SIMILAR EXERCISE WITH
THE SAME PATIENT AND THIS ONE
SHOWED NO CHANGE IN THE
SENSORY MOTOR AND SMA AREA.
YOU CAN ONCE AGAIN SEE THE F
MRI CHANGED WITH D BS TURNED
ON TO PREDICT A BEHAVIOR THAT
USUALLY TAKES WEEKS TO SHOW IN
THE CLINIC.
SO THIS WAS AGAIN A GOOD PROOF
OF PRINCIPLE ISSUE WHILE IT IS
HELPFUL FOR PATIENTS WITH
PARKINSON'S, IT CAN BE USED
FOR OTHER BEHAVIORS WITH
SIMILAR RESULTS.
SO IN CONCLUSION, I HOPE I
HAVE CONVINCED YOU THAT
PATIENTS WITH PARKINSON'S
DISEASE CAN BE BENEFITTED FOR
F MRI AND D BS BUT FIRST WE
MUST UNDERSTAND THE EFFECTS OF
D BS AND UNDERLYING MECHANISM
TO DO IT PROPERLY.
AND THERE IS ALSO A THOROUGH
SAFETY UNDERSTANDING AND
TESTING REQUIRED AND OBJECTIVE
AND RAPID BIOMARKERS OF D BS
EFFICIENCY FOR WHICH
PROGRAMMING IS EVEN MORE
DIFFICULT.
SO THIS IS MY THANK YOU AND
THIS IS MY E-MAIL AND THANK
YOU.
[APPLAUSE]
>>THANKS SO MUCH FOR THE
AWESOME TALK.
IS THERE ANY QUESTION FROM THE
AUDIENCE?
>>MY NAME IS WANG AND I AM
FROM ABBOTT AND WE MAKE D BS
DEVICES SO I CAN DO A DEMO
MAYBE DURING LUNCH TIME ON HOW
TO PHASE ALL THAT.
BUT MY QUESTION TO YOU IS WHEN
WE USE FUNCTION MRI TO LOOK TO
SEE HOW D BS PROGRAMMING IS
EFFECTIVE OR NOT, ARE WE JUST
LOOKING AT THE CHANGE OF THE
SIGNAL OR JUST LOOK HOW BRIGHT
THE SPOT IS OR ARE WE LOOKING
FOR SOMETHING ELSE, RIGHT,
LOOKING AT LOCATION OF THE
ELECTRODES?
>>OH, SO WHEN WE STARTED
THIS, WE HAD ABOUT 10 PATIENTS
AND I SAT THERE AND LOOKED
VISUALLY AT ALL THEIR PATTERNS
AND I COULD PROBABLY GET ABOUT
10 PERCENT RIGHT ON HOW WE
WOULD COME UP WITH THE DATA,
THEN THERE WAS EXCLUSIVE AREAS
WHERE THERE WERE SIDE EFFECTS.
SO THE IDEA IS WE WANT THE
SUPER HOT MOTOR EFFECTS BUT WE
CANNOT HAVE THIS NEGATIVELY
IMPACT THE PATIENT.
IT REQUIRES US TO FIND SOME OF
THIS DATA AND NOW LEARNING
DEEP LEARNING IN A WHOLE GRAIN
PATTERN, WE NOT ONLY
UNDERSTAND WHAT IS DRIVING IT
BUT THAT THE ACCURACY BE
99 PERCENT CORRECT.
SO YOU GO FROM FULLY
UNDERSTANDING THE DATA AND
ENSURING FOR YOU IT IS MORE
ACCURATE AND THEN DRIVING THE
RESULT.
>>AND ARE THERE DIFFERENT
MARKERS FOR DIFFERENT
DISEASES, FOR EXAMPLE,
DEPRESSION VERSUS ALZHEIMER'S
OR PARKINSON'S DISEASE, ARE
THERE DIFFERENCE IN PARTS OF
THE BRAIN OR PERHAPS THE
PATTERN OF THE BRAIN?
>>YES, WE LOOKED AT TEN
DIFFERENT PATIENTS AND WE
NEEDED TO SEE EACH PATTERN.
ON SOME PATIENTS WHERE THERE
WAS IMPAIRMENT IN THE
PARABELLUM, WE CAN GREEN LIGHT
AND SAY WELL AT LEAST THERE IS
A PATTERN.
AND THAT DEPENDS WHERE THE
ELECTRODE IS.
>>AND MY LAST QUESTION, I
THINK IT IMPORTANT TO BE ABLE
TO PREDICT WHICH PATIENTS GET
A RESPONSE ABOUT THE BRAIN
BEFORE WE STICK AN ELECTRODE
IS THE BRAIN.
CAN YOU DO THAT?
>>YES, SO THIS QUESTION IS
PROBABLY MORE RELEVANT FOR
DEPRESSION WHERE THE RATE IS
MUCH HIGHER SO WE HAVE AN
IMPLEMENTATION WHERE WE ARE
AIMING AND LOOKING AT BRAIN
SHAPE AND RELEVANT NETWORKS IN
THE BRAIN THAT WE MAY ACCESS
IN THOSE PATIENTS.
SO YES, DEPRESSION AND
PSYCHIATRIC DISORDER, THIS
QUESTION IS MORE RELEVANT BUT
FOR PARKINSON'S --
[INDISCERNIBLE]
>>THANK YOU VERY MUCH.
>>THANK YOU SO MUCH FOR THE
ANSWERS.
[APPLAUSE]
SO THE NETWORKS SPEAKER IS
FROM THE CLEVELAND
CLINIC-OHIO, Dr. KEN AND THE
TITLE OF THE TALK WILL BE DPS
TECHNICAL BASES AND SAFETY --
BASIC SAFETY FOR REALTIME
ACTIVE D BS.
>>MY NAME IS Dr.
BHATTACHARYYA, KEN COULD NOT
BE HERE SO IF YOU LIKE
SOMETHING IN THE TALK, TELL I
AM.
FIRST WE WILL LOOK AT WHY YOU
WANT TO HAVE SAFETY FOR D BS
AND HERE ARE A FEW DETAILS
THAT ARE VERY INTERESTING.
HERE ARE F MRI RESPONSES IN
TWO PATIENTS.
ONE DID NOT RESPOND WELL AND
ONE RESPONDED VERY WELL.
WHAT I WOULD LIKE TO POINT OUT
ARE THAT YOU CAN SEE VERY
DIFFERENT PATTERNS OF
ACTIVATION AND DEACTIVATION IN
THE PERSON WHO RESPONDED WELL
AND WHO DID NOT RESPOND WELL.
THE OTHER THING I WOULD LIKE
TO APPOINTED OUT FROM A
NEUROSCIENTIFIC POINT OF VIEW,
THIS IS A VERY RICH SCHEME OF
NETWORKS BEING ACTIVATED.
SO YOU THINK ABOUT A STANDARD
FINGER TAPPING TEST, THAT IS
ACTIVATING ALL SORTS OF
NETWORKS IN YOUR BRAIN.
THIS IS MORE CONTROLLED IN A
SENSE AND ONE MORE THING I
WOULD LIKE TO POINT OUT IS YOU
SEE THIS DOWN REGULATION IN
CEREBRAL SPINAL FLUID, I WILL
GET TO THAT IN A MOMENT, THAT
IS NOT REAL BUT HIGHLIGHTS WHY
WE WANT TO DO THIS WORK?
A. AND ONE OF THE OTHER CASE
BUILDING ON Dr. BATTA'S
WORK, YOU CAN LOOK AT THE
FREQUENCY, THE ON AND OFF OF
30 SECONDS AND THEN 2 SECONDS
ON AND 28 SECONDS OFF.
SO SOME INTERESTING RESULTS,
THE TORONTO GROUP IN 1999, I
WAS THERE FOR 3TS WHICH IS
SCARY TO BE AROUND.
THE SAFETY CONSIDERATIONS ARE
MIND BLOWING, THE MAIN
TAKEHOME MESSAGE, DON'T USE
INTERNAL 3T IF YOU CAN
POSSIBLY AVOID IT.
WHAT I MEAN BY INTERNALIZED GO
LEADS, WE HAD LEADS OUTSIDE
THE PATIENTS' HEADS AND THEN
PLACED THE PATIENT IN THE
CONTROL ROOM AND BACK IN THE
OLD DAYS, THEY WERE MAGNETIC
AND YOU COULDN'T USE THEM IN
THE MRI SAFELY BUT THERE IS A
LOT OF INTEREST AND IT CAN BE
DONE.
SO YOU NEED TO DO YOUR OWN DUE
DILIGENCE.
THE REASON WHY IS EVEN THOUGH
CERTAIN IMPLANTED D BS SYSTEMS
HAVE BEEN FDA APPROVED FOR
USE, THE APPROVAL IS ONLY
VERY, VERY LIMITED, THERE
UNDER CERTAIN POST SEQUENCES,
STAR LIMITS AND FIELDS THAT
ARE APPROVED AND PEOPLE HERE
PROBABLY TO WANT DO SOMETHING
MORE ENVELOPE-PUSHING THAN
WHAT IS ALLOWED BY THE FDA.
SO IF IT IS SOMETHING YOU
REALLY WANT TO DO, YOU MUST
EVALUATE SAFETY BEFOREHAND.
SO FOR THIS TALK, I WILL BREAK
DOWN THE SAFETY RISKS AND GO
THROUGH THEM STEP BY STEP.
THE FIRST ONE IS FORCES.
THIS IS THE MOST MANAGEABLE OF
THEM BUT FIRST I WANT TO POINT
OUT THAT ALL OF THESE
PROBLEMS, ALL OF THESE SAFETY
RISKS ARE ASSOCIATED WITH ONE
AND THREE MAGNETIC FIELDS,
THERE IS GRADIENT
ELECTROMAGNETIC FIELDS AND
THERE IS A BIG FIELD, 4.75 AND
7 TESLA.
AND THEN POINT OUT THERE ARE
TWO TYPES OF MAGNETIZATION TO
WORRY ABOUT AND IT RELATES TO
MATERIALS OF THE IMPLANT.
AND MANY OF THESE IMPLANTS ARE
NOT COMPATIBLE WITH MRI AND
THE REASON I CHOSE THIS IMAGE
FROM GOOGLE IS THAT
FERROMAGNETISM --
[INDISCERNIBLE]
, THIS IS AN ALUMINUM PIECE
AND I ENCOURAGE YOU TO DO THIS
IN YOUR LAB.
YOU TAKE A SHEET OF METAL,
WATCH IT SLOWLY DRIFT TO THE
GROUND, NOTHING MAGNETIC ABOUT
THE MATERIAL ITSELF BUT A
STRONG MAGNETIC CURRENT WILL
ALLOW IT TO FLOAT TO THE FLOOR
SO YOU REALLY HAVE TO DO YOUR
DUE DILIGENCE.
NOW, AGAIN WHEN YOU ARE
TALKING ABOUT FORCES, YOU ARE
PUSHING METAL INTO A REALLY
STRONG MAGNET AND THE RISK TO
WORRY ABOUT, PATIENTS MOVE AND
THAT CAN DAMAGE VERY SENSITIVE
TISSUE.
THERE ARE TWO FORCES TO WORRY
ABOUT, THE LAYER AND ROW --
OHATIONAL FORCE AND MOST OF
THE TISSUE DAMAGE HAPPENS WHEN
YOU ARE PUSHING THE PATIENT AT
THE MAGNET.
NOW, YOU SUE ABLE -- YOU
SHOULD BE ABLE TO HAVE IT BE
SAFE FOR THE PATIENT.
NOW THIS IS AN INTERESTING
CLASS OF HOW IT CAUSES DAMAGE.
IF YOU PUT A PATIENT INTO THE
SCANNER AND YOU SCAN THEM WITH
D BS, THAT MEANS THAT THERE
ARE CERTAIN -- DEFINITELY
DON'T WANT THAT TO HAPPEN.
BUT THERE IS A RISK HERE IN
THE SCIENCE WHERE YOUR D BS AT
THE IMPACT POINT MAY NOT
BEHAVE WHEN THE SCANNER IS
RUNNING.
WE DID AN SW-G THING ON THE
RETINAL PROCESS -- DID
SOMETHING ON THE RETINAL
SCANNER EYE, THE RISKS
INVOLVED UNNECESSARY SURGERY,
SURPRISING BEHAVIOR OF THE
DEVICE IN ANY OF THE THREE
FIELDS AND IN THE EBBED, THIS
WAS HA HARD THING TO OVERCOME
BECAUSE YOU NEED BUY-IN FROM
THE MANUFACTURER TO DO THIS.
AFTER THE TESTING, YOU CAN'T
USE THEM IN A SURGERY TOWARDS
THERAPY SO THAT IS ABOUT A
MILLION DOLLAR OPT
OPPORTUNITY COST SO YOU REALLY
NEED A MANUFACTURER TO BE
COMMITTED TO THIS.
NOW, WE HAVE INDUCED VOLTAGES,
CREATES CURRENTS IN THE
CONDUCTOR AND EACH OF THE
ELECTROMAGNETIC FIELDS CAN
CAUSE THIS SORT OF VOLTAGE AND
ONE IS THAT YOU CAN CREATE AN
ACTION POTENTIAL.
THERE IS A DOCUMENT CASE IN
2021 OF SIDE INFECTION AND
THIS IS A RADIO GRAPH OF THE
COILS FOR THE LOOPS AND EACH
OF THESE LITTLE LOOPS HERE IS
AN ANTENNA FOR CAPTURING
ACTIVITY.
THERE IS OTHER RESEARCH AND
THIS IS Dr. DAVIDSON'S PAPER
WITH ARTIFACTS AND THIS IS THE
PART OF THE BRAIN THAT YOU
REALLY CARE ABOUT, YOU HAVE TO
DO YOUR DUE DILIGENCE TO MAKE
SURE YOU WILL BE ABLE TO PULL
OFF THE EXPERIMENT.
AND FINALLY THIS IS THE SCARY
ONE, HEATING, THE ONE THAT
EVERYONE WORRIES ABOUT.
AND IT CONNECTS HOME BECAUSE
WE HAD A PATIENT LIKE THIS AT
OUR SITE.
WHAT IS INTERESTING IS THIS
PATIENT HAD A BILATERAL D BS
IMPLANT AND THE TREATMENT WENT
QUITE WELL BUT A FEW MONTHS
LATER, THE PATIENT WENT IN FOR
A REGULAR LUMBAR SPINE MRI,
HAD NOTHING TO DO WITH THE
PARKINSON'S AND AFTER THE
SCAM, THERE WAS AN EXAMPLE AND
FOUND A HEMORRHAGE.
SO THE SUBJECT WAS A HUNTER
AND SO THE PULSIMETER EYE WAS
PLAINS D IN AN UNUSUAL -- WAS
PLACED IN AN UNUSUAL PLACE.
SO THERE IS PHANTOM TESTING
WHERE YOU USE A GEL AND WHEN
YOU REMOVE THE GEL, YOU CAN
SEE WHAT IS UNDERNEATH.
YOU HAVE THE ELECTRODES, THE
FIBER-OPTIC PROBE AND USE THE
ELECTRICAL POINT CONTACT WHERE
THE MEASUREMENT IS DONE AND
THIS IS OVER WHERE YOU CAN SEE
AT THE TIPS USUALLY WHERE THE
PROBLEM IS, THERE IS A
REFERENCE TEMPERATURE AND YOU
WANT TO MAKE SURE THE
PROGRAMMABLE, THE PULSE
GENERATOR DOES NOT HEAT UP
EITHER.
SO IN THIS TEST FOR HEATING,
THE FIRST CASE THERE WAS NO
HEATING WHICH IS NOT TOO BAD
BECAUSE YOU WANT TO MAKE SURE
YOUR PROBES ARE WORKING.
SO YOU USE SAFE HEATING TO
MAKE SURE THE ELECTRICAL
PROBES ARE HEATING AND THEN
THERE IS UNSAFE HEATING,
REALTIME TEMPERATURE VERSUS
HIGH.
SO AS PULLS IS GOING -- AS THE
SPIN ECHO IS RUNNING, YOU CAN
SEE THIS DRAMATIC RISE,
BASICALLY A PHANTOM, NOT IN
VIVO BUT IF THERE WERE IN A
PERSON, YOU WOULD SMELL SMOKE
AND IT WOULD BE VERY DANGEROUS
SO WE DON'T DO THIS SEQUENCE
IN PATIENTS OR IN VIVO.
AND THIS IS ANOTHER REASON WHY
YOU DO TESTING AND A SLIGHT
CHANGE IN CONFIGURATION CAN
TAKE YOU FROM NO HEATING TO
DRAMATIC HEATING AND HERE ALL
THEY DID WAS DISCONNECT THE
HEATING IN POST ELECTRODES AND
THIS SHOWS YOU IF THE
INSULATION WAS FRAYED ON THE
ELECTED TODAY'S, YOU --
ELECTRODES, YOU CAN GET UNSAFE
HEATING.
THIS SHOWS THERE WAS SOME
RESPONSE TO HEATING DURING
SHIM BUT NOT DURING THE COURSE
OF THE EVENT.
SO ALL THE STUFF THAT IS QUITE
ARDUOUS AND CURIOUS WITH
STIMULATION, THIS WAS DONE
WITH BOB BROWN TRYING TO FIND
SOME PRINCIPLES OF SAFETY AND
THIS IS THE ILLUSTRATION OF
THE CHALLENGE PHYSICALLY.
EVERY PATIENT WILL HAVE A
DIFFERENT CONFIGURATION OF
ELECTRODES AND LOOPING.
PRIOR YOU COULDN'T ALWAYS GET
THE CLINICIANS TO LAYOUT THE
WIRES FROM THE ELECTRIC
TODAY'S IN THE SAME POSITION
BUT UNIVERSALLY THIS MAKES
TESTS DIFFICULT TO DO.
SO YOU WANT SOME
STANDARDIZATION OF PLACEMENT
OF ELECTRODES FOR WORKFLOW,
YOU SHOULD ALWAYS READ THE
MANUAL.
EVERY GROUP HAS SAFETY
GUIDELINES.
THEN TEST EVERY MANAGEABLE
CONFIGURATION, SURVIVABILITY,
PHANTOM TESTING, CHECK YOUR
IMPEDE DANCES AND COMPUTATIONA
L MODERATE KEL DEL WHERE YOU
ARE MAKING ADVANCES BUT YOU
HAVE TO GO BACK TO BE SURE.
NOW YOU SHOULD TEST EVERY
IMAGINEABLE CONFIGURATION.
GENERALLY THE T/R COIL IS
SAFER THAN THE BODY COIL.
THE LOWER FIELD IS GENERALLY
SAFER AT LOW RESOLUTION.
IF YOU WANT TO GO TO HIGHER
FIELDS, GO TO 17, GUARANTEED
THERE ARE NO DEVICES FDA
APPROVED FOR 17 BUT
EXTERNALIZED LEADS SHOULD BE
AVOIDED ABSENT SAFETY TESTS.
AND NOW I WILL TAKE QUESTIONS.
>>THANK YOU FOR THE
INTERESTING TALK.
ANY QUESTIONS FROM THE
AUDIENCE?
>>I HAVE ONE QUESTION TO
START.
SO THERE ARE OBVIOUS
ADVANTAGES TO DOING
LONGITUDINAL STUDIES IN PEOPLE
WITH ADS TO UNDERSTAND THE
CHANGES IN TIME.
ARE THERE INCREASED RISKS WITH
REPEATED SCANNING IN
INDIVIDUALS OR IS IT CASE BY
CASE?
>> ALWAYS CASE BY CASE BUT I
THINK THE RISK IS MORE IN
SOMETHING CHANGED.
>>I SEE.
>>AND NOT JUST IN THE PATIENT
BUT THERE ARE INTERESTING
RESULTS THAT SHOW IF YOU GO
FROM ONE SCANNER TO ANOTHER,
BASICALLY THE SAME MODERATE
DEL THERE, SHOULD BE THE -- SO
WHEN YOU DO MRI YOU GET A
SPECIFIC BE A, SO RATE AND
MOST TVERDOVSKY MOST VENDORS
SAY IF THE SAR IS BELOW A
CERTAIN LEVEL, THAT IS OKAY.
BUT IT IS HARD TO GET THAT
INFORMATION FROM THE
MANUFACTURER.
SO YOU COULD SCAN THE SAME
PERSON ON THE SAME SCANNER BUT
HAVE A SOFTWARE UPGRADE IN
BETWEEN AND THE SAR
MEASUREMENT MAY BE TOTALLY
DIFFERENT.
SO THAT IS THE SORT OF THING I
WOULD WORRY ABOUT.
>>WHAT IS THE SOLUTION?
>>TO DO THE TESTING AND MAKE
SURE THE SAR IS ONE THAT HAS
BEEN TESTED BEFORE DOING IT
AGAIN.
>>I HAVE A QUESTION THAT YOU
PROBABLY HAVE HEARD MANY TIMES
NOW.
I HAVE HEARD PEOPLE SAY THAT
IS FROM 2005 AND NOW 2022,
THAT IS THE ONLY INJURY I HAVE
SEEN.
DOES THAT MEAN IT IS
PROACTIVELY SAFE TO SCAN
PATIENTS?
>>WELL, I WILL ADD TO THAT,
THAT IT SCARED THE BEJESUS OUT
OF PEOPLE SO THEY ARE VERY
CAREFUL WHEN THEY DO IT.
LIKE IT IS SAFE TO FLY BUT YOU
WANT TO STILL BE CAREFUL.
>>IT IS 1.5 TESLA, YES.
>>ONE LAST QUESTION?
>>A REACTION TO THE LAST
QUESTION, IT IS QUITE SAFE BUT
THESE PATIENTS WITH OFFLABEL,
DID NOT ABIDE BY MANUFACTURER
GUIDELINE.
SO IF YOU STAY WITHIN A
CERTAIN CONDITION, IT IS FINE.
>>OR YOU CAN AT LEAST BLAME
THE MANUFACTURER.
[LAUGHTER]
>>YEAH, I DON'T KNOW.
THE OTHER THING I WANTED TO
REACT TO IS THE PICTURE YOU
SHOWED AND I THINK IT WAS AN
MRI IMAGE CLOSER TO THE RI.
THE TESTING DONE WITH 3T, I
HAVE ACTUALLY DONE SOME LOOPS
OF TESTING AND MAINLY OF
INTEREST TO THE MANUFACTURER,
IT IS MAINLY DUE TO THE
CONNECTOR YOU FEED IN WITH THE
EXTENSION CABLE AND ALSO DUE
TO THE FIXATION GROUP WHICH IN
MY MIND REALLY DOESN'T HAVE TO
BE METAL, IT CAN BE SOME SORT
OF PLASTIC.
SO IT IS AN INTERESTING THING
BECAUSE YOU COULD CHARGE-BACK
THIS, NOT CHANGE AT ALL THE
LEAD SO YOU DON'T HAVE TO
REALLY GO BY THE --
[INDISCERNIBLE]
>>VERY OBVIOUS CONTRIBUTORS
TO PROBLEMS THAT YOU ALWAYS
HAVE TO WORRY ABOUT.
>>THE THANK YOU SO MUCH, WE
ARE BEHIND TIME SO MAYBE WE
SHOULD CONTINUE THIS
DISCUSSION ARREST AFTER THE
TALK SO LET'S THANK THE
SPEAKER ONE MORE TIME.
[APPLAUSE]
>>THE NEXT TALK, D BS TARGETS
FROM NEURALLIC DISORDERS
EPILEPSY AND REALTIME BY Dr.
MID ERIK MIDDLEBROOKS.
>>THANK YOU VERY MUCH.
I HAVE SOME DISCLOSURES TO
MAKE.
THERE ARE VARIOUS METHODS TO
DO NEUROMODULATION, PROBABLY
THE MOST UTILIZED ARE
ESSENTIAL TREMORS AND
PARKINSON'S, INCLUDING O C D
AND EPILEPSY SO HE BUT COULD
BE OTHERS WITH RESEARCH THAT
COULD STAND TO GET APPROVAL BY
FDA.
SO FDS IS A GOLD STANDARD AND
A GOOD MODEL HOW IT IS
INTEREST GRADE INTO
NEUROMODULATION.
THE STEREOITAXY IS HOW WE
COORDINATED THE PATIENTS SO WE
USED SOME SORT OF DIRECT
STRUCTURAL TARGETING LIKE THE
AC-PC LINE AND WE COULD SEE
THE BOUNDARIES OF SOME OF THE
STRUCTURES WHERE WE ARE
INTEGRATING BETTER.
BUT I THINK MORE RECENTLY WE
HAVE SEEN A SHIFT TO DIRECT
FUNCTIONAL TARGETING WHERE
INSTEAD OF JUST SPEAKING IN
TERMS OF CERTAIN NUCLEI THAT
WE MAY OR MAY NOT SEE, LIKE
THE THALAMUS, WE MAY NOT SEE
THE INTERNAL STRUCTURE, BUT
LOOKING AT THE DIRECT
FUNCTIONAL TARGETING AND
FUNCTION AND HOW WE REGULATE
THEM.
SO PROBABLY THE MOST COMMON TO
BE UTILIZED, THERE ARE MANY
APPROVED METHODS.
YOU CAN SEE A BLOCK DESIGN
WHERE STIM EFFECTS ARE
MEASURED DURING SIMULATION OR
THERE COULD BE OTHER TASKS OF
INTEREST PERFORMED WITH AND
WITHOUT D BS.
THE SECOND IS RESTING STATE
ALTERATIONS AND THIS
COULDCOMPARED DURING STIN ON
AND OFF STAGE OR LOOK AS A
LONG-TERM SITUATION WHERE YOU
HAVE A STIM AFTER SURGE REAP
AND THEN COMPARE THE BASELINE
AND THE POST-OP AFTER
LONG-TERM STIMULATION.
SO AS YOU HAVE HEARD IN
PREVIOUS TALKS, THERE IS A LOT
OF DIFFERENT WAYS WE CAN LOOK
AT THIS MODEL.
SO WE MEASURE THE IN RECEIVE
VERY EFFECTS OF STIM SETTINGS
BUT IT IS QUITE THE COMPLEX
MODEL TO SIMULATE.
ADDITIONALLY WE SEE DEVICES OF
GREATER COMPLEXITY IN THE
PROGRAMMING OPTIONS INCLUDING
THINGS LIKES DIRECTIONAL
ELECTRODES.
AS WE SAW WITH OTHER FORMS OF
MODULATION, EVEN AN ODIC AND
CATHODIC STIMULATION CAN
PRODUCE A DIFFERENT EFFECT.
LASTLY CAN WE LOOK AT CLINICAL
BIOMARKERS AND WE HEARD A
LITTLE ABOUT THIS ALREADY AND
I THINK A NEW INDICATION FOR D
BS WHERE WE DON'T HAVE A
IMMEDIATE BIOMARKER SO THOSE
INCLUDE THINGS LIKE EPILEPSY,
DEPRESSION, DYSTONIA AND
DIMENSION WHERE YOU HAVE THE
IMMEDIATE CLINICAL BIOMARKER
LIKE IMMEDIATE CHANGE TO
FACIAL EXPRESSION.
SO WE WANT TO LOOK AT
IMPROVING THE UNDERSTANDING OF
THE MECHANISM AND CLINICAL
BIOMARKER WITH PARKINSON'S AND
EPILEPSY.
I WON'T SPEND A LOT OF TIME
BECAUSE WE HAVE MENTIONED THIS
EARLIER BUT IT IS THE LARGEST
STUDY WITH D BS F MRI AND WE
HAVE EXAMPLES ON HOW TO DO
THIS AND DISENTANK BELL SOME
ENTANGLE SOME OF THE CLINICAL
OPTIONS WE USED IN D BS.
OBVIOUSLY THERE IS SOME
VARIABILITY IN STUDIES AND TO
LOOK AT THE EXAMPLE STUDY TO
SEE WHAT I AM TALKING ABOUT,
IN THIS STUDY WE SEE
ACTIVATION IN THE M1 AND IN
THIS STUDY, WE SEE ACTIVATION
VERSUS DEACTIVATION IN THE M1
AND THEN FAILURE TO SEE
ACTIVATION IN GP AND
CEREBELLUM.
SO IF YOU LOOK AT THE FIRST
GROUP HERE, THESE ARE PATIENTS
WHO HAD S BS AND THESE
PATIENTS HAD STIMULUS IN THE
MOTOR CORTEX.
WHY ARE THESE DIFFERENT BASED
ON THE APPARENTLY POPULATION?
THE TREMOR POPULATION, WE KNOW
THEY HAVE THIS M1 AND WE CAN
HYPOTHESIZE THIS IS NORMALIZED
REACTING IN A REACTIVE
DEACTIVATION OF M1.
MEANWHILE WITH THE HYPERACTIVE
GROUP, WHEN WE NORMALIZE THE
INDIRECT PATHWAY, WE WIND UP
WITH A M1 ACTIVATION.
SO HOW DO WE EXPLAIN THIS
GROUP?
WE ACTUALLY SEE THE STN AND
GPI HAVE DIFFERENT EFFECTS.
SO IN THIS PATIENT, IT WAS
RESPONDED THE F GI NEEDED MORE
INSPECTION IN THIS GROUP BUT
THE QUESTION IS WHY ARE THERE
DIFFERENT SETTINGS?
SO ONE OF THE PATHWAYS ARE
THROUGH THE HYPER DIRECT
PATHWAY, WE CAN REDUCE INHIB
WAGES ON THE THALAMUS CAUSED
BY PPN.
THESE UNIQUE PATHWAYS MAY
EXPLAIN THE DIFFERENCE BETWEEN
GPI STIN AND PIGD AND THAT IS
WHAT WE SEE.
SO TO SUMMARIZE THIS, THE
EFFECTS CAN VARY AND THIS CAN
RELATE TO STIMULATION AND
TARGETING FACTORS WHICH I WILL
TALK TO IN A MOMENT BUT JUST
HERE YOU CAN SEE THE SIMILAR
PHENOTYPES IN THE SAME DISEASE
PROCESS HAVE DIFFERENT
EFFECTS.
SO WE LOOK AT ACUTE
STIMULATION EFFECTS AND CAN BE
RELIED TO MANY STIMULATION AND
TARGETING FACTORS.
SO NEXT WE WILL TALK ABOUT
EPILEPSY AND THIS WAS THE MOST
RECENT APPROVAL AND WE FOCUSED
ON THE THALAMUS.
AND WHAT LED TO EVEN MORE
TRIALS WAS A SOMEWHAT MIXED
RESPONSE.
IT WAS SOMEWHAT IMPROVED OVER
THE LONG-TERM BUT LOOKING AT
THE PATIENTS ENROLLED OVER THE
STUDY, THE GREATEST RESPONSE
WERE THOSE WITH TEMPORAL LOBE
SEIZURES.
SO WHY DO SOME PEOPLE RESPOND
AND OTHERS DON'T RESPOND?
SO WE LOOKED AT ACTIVATION AND
DEACTIVATION IN THE NEURAL
NETWORKS TECHNIQUE THAT WAS
MENTIONED EARLIER, WE LOOK AT
THE VTA AND THE STIMULATION
VOLUME AND WHAT WE SEE IS THE
RESPONDERS HAVE POSITIVE
CORRELATION WITHIN THE LIMBIC
DEFAULT MODE AND STIMULATION
IN THE CORTICO NETWORK.
SO WHEN YOU LOOK AT THE
PARADIGM, WHAT YOU SEE IS THE
ACTIVATION IS IN THE NETWORKS
AND THEN YOU HAVE THE BROAD
DEACTIVATION AND THIS
CORRELATES WELL WITH WHAT WE
SUE AS THE DIFFERENCE BETWEEN
THE RESPONDERS AND THE
NONRESPONDERS.
SO THE QUESTION IS, ARE YES,
THIS IS THE VIDEO SHOWING WHAT
IS HAPPENING STIMULATING ON
AND OFF BUT THE QUESTION IS
HOW DOES THAT EXPLAIN WHY WE
HAVE RESPONDERS AND ARE
NONRESPONDERS IF WE'RE
TARGETING IN THE SAME WAY?
SO IF YOU LOOK AT THE
INDIVIDUAL PATIENTS, I SHOW
YOU FIVE PATIENTS HERE AND
DESPITE SPAEURBTS 1, 3 AND 5
HAVE VERY SIMILAR PATTERNS,
YOU HAVE THIS CORTICO
DEACTIVATION AND THEN
ACTIVATIONS WITHIN THE
NETWORKS AND PATIENTS 2 AND 4,
VERY VERY DIFFERENT.
THEY DON'T HAVE ACTIVATION IN
THE SUBCORTICAL AND THEY DON'T
HAVE THE DEACTIVATION IN OTHER
AREAS.
SO WHY THE DIFFERENCE?
WE TESTED THIS AND PLACED
ELECTRODES IN THE HIPPOCAMPUS
AND STIMULATED THE ANTERO
NUCLEUS AND YOU CAN SEE THE
POTENTIAL IN THE HIPPO CAMPUS
IN THESE PATIENTS HOWEVER WE
DON'T MEASURE THAT.
SO IT TURNS OUT THESE PATIENTS
HAVE MULTIPLE SCLEROSIS AND
THIS HIGHLIGHTS DAMAGE IN ANY
NETWORKS MAY MINIMIZE THE
EFFECT OF STIMULATION
THROUGHOUT THE NETWORKS WHICH
EXPLAINS WHY WE SEE DIFFERENT
PATTERNS AND WHY PATIENTS
DON'T RESPOND.
SO ONE OF THE INTERESTING
QUESTIONS IS IF THAT IS TRUE,
CAN THIS DIRECT THE NETWORK
PATTERNS OF PATIENTS WHO DO
AND DON'T RESPOND TO
STIMULATION.
SO THIS STUDY INVOLVED THOSE
WITH TYPICALLY LIMBIC NETWORKS
AND WHY TARGET THE SAME
NUCLEUS FOR ALL FORMS OF
EPILEPSY.
THIS PARTICULAR TARGET OF
INTEREST IN EPILEPSY FOR
PATIENTS WHO HAVE
PERRY-ROLANDIC ACTIVITY, WE
HAVE A SLIDE MODEL OF THIS AND
WHAT WE SEE IS WHEN YOU
STIMULATE WITH HIGH FREQUENCY
SIMULATION, IT DOES ACTIVATE
AREAS OF THE CENTRAL MOTOR
NETWORK WHERE THE
PERERI-ROLANDIC, WE WILL SEE
SOME ACTIVATION IN SOME AND
NONE IN OTHERS.
SO THIS SUPPORTS THE CONCEPT
OF HAVING NETWORK SPECIFIC
TARGETING IN EPILEPSY D BS.
NOT ALL PATIENTS ARE EQUAL AND
WE HAVE TO CONSIDER THAT WHEN
WE CHOOSE THE TARGET.
SO ONE OF THE THINGS TO KEEP
IN MIND WITH EPILEPSY AS
OPPOSED TO OTHER NEURALLIC
ORDERS, THE GROUP MAY HAVE A
PATIENT VARIABILITY IN THE
NETWORK PATHO PHYSIOLOGY.
AND ONE OF THE QUESTIONS IS
CAN CM AND ANT HIGHLIGHTS HAVE
A POTENTIAL OF
NETWORK-SPECIFIC TARGETING.
YOU CAN SEE THAT THEY HAVE
THIS BROAD RS ACROSS THE AREA
AND SO THEY ARE NOT A GREAT
CANDIDATE BUT WHAT WE DID WAS
LOOK AT THE SAME GRID WHERE
THEY HAVE THE ONSET OF
SEIZURES AND CORRELATED THIS
WHOLE AREA AND PLANTED A
ELECTRODE WHERE THAT GRID WAS
AND THEN PUT A DEPTH ELECTRODE
WITHIN THIS AREA THAT WE
DETERMINED FROM THE RESTING
STATE NETWORK AND YOU CAN SEE
FROM THE RECORDINGS THAT WE
HAVE NEAR SIMULTANEOUS SPIKING
FROM THE CORTEX AND THE
SUBCORTEX.
SO THIS SHOWS THAT INDEED THE
RESTING STATE PREDICTED THIS
NETWORK THAT WE WERE TARGETING
AND THEN WE CAN SEE HERE ON
THE LONG-TERM OVER ONE YEAR,
THE MAGNET SWIPES ON THE
PATIENT WHEN HAVING SEIZURES
THAT THEY DECREASED OVER ONE
YEAR.
SO NOW I WILL SWITCH GEARS AND
TALK ABOUT MODEL STIMULATION
IN VIVO AND THE FREQUENT SEE
EFFECT.
THE RECOMMENDED STRODE HAVE
BEEN A GREAT THING TO HAVE IN
OUR ARSENAL FOR D BS AND WE
SEGMENT THEM IN INDIVIDUAL
CONTACTS OF VARYING GEOMETRY
THAT ALLOWS US TO DO RATHER
THAN MORE SPECIFIC CALL
STIMULATION VOLUMES, WE CAN DO
MORE SPECIFIC TESTING AND GO
PERFORM A FIELD THAT GOES TO
THE BOUND DREAMS A--
BOUNDARIES TO THE STRUCTURE
AND IT PLAYS A HUGE ROLE IN
WHAT THE STUDY WILL BE.
SO THIS IS LOOKING AT THE
STIMULATION, ROTATING AROUND
THE ELECTRODE IN DIFFERENT
ANGLES AND WHAT THIS IS
ULTIMATELY DOING IS AFFECTING
THE VALUE OF THE ACTIVATION.
SO THIS IS WHERE THE
STIMULATION IS OCCURRING AND
INDEED ACROSS THE IMPLANTS,
THE STIMULATION PATTERN AS
THEY ROW ROTATED AROUND HAD
MEDIAL AND LATERAL POSTERIOR
AREAS.
SO IF WE KEEP THE POSITIONING
THE SAME BUT AFFECT THE
E-FILL, HOW DOES THAT STUDY
TURN OUT?
WELL, A GOOD ANSWER TO THAT,
IN STIMULATING THESE PATROLS
IN PARKINSON'S, WE CAN STAY
AWAY FROM THE ON TARGET SITES
LIKE CENTRAL NUCLEUS AND
CAPSULE AND WILL HAVE THIS
ORIENTATION OF THE TARGET BUT
IT CAN HAVE A HUGE DIFFERENCE
ON THE TRACT.
SO THIS WE SEE THE ANIMAL
MODEL AND WE SEE IN THE
CORTICO RECORDINGS, THE
CURRENT CHANGES TREKS AND
AFFECT ON THE NEURONS CHANGES.
SO STIMULATION VOLUME IS
SELECTIVELY THE SAME BUT WE
CAN USE THESE AS MODELS FOR
ROTATING THE CONTACTS AROUND
AND STIMULATING DIFFERENT AN
TOMMIC AREAS, KEEPING THE
CONTACTS THE SAME BUT CHANGING
THE LOCATION OF THE FIELDS AND
WHEN WE DO THAT, YOU CAN SEE
THE STIMULATION IN THE SAME
VOLUME OF TURN IT WILL CHANGE
THE EFFECT OF THE NETWORK
AREAS.
SO NOW I WANT TO TALK ABOUT
THE FREQUENCY EFFECTS AND
THERE IS STIMULATION DATA ON
STIMULATION FREQUENCY IN D BS
AND THIS IS POORLY UNDERSTOOD.
THE SENSITIVITY OF GM VERSUS
WM STIMULATION FREQUENTLY IS
DEPENDENT AND BECAUSE OF THE
HIGH FIRING RATE AND SHORT
STIMULATION, THE LONG
FREQUENCY INDUCES LONG-LASTING
HYPER POLARIZATION WHICH
REDUCES THE OVERALL FIRING
RATE.
SO WE TALKED ABOUT 145
145-HERTZ AND WE ALSO SEE THIS
WITH THE 30-HERTZ STIMULATION.
IT HAD A SIMILAR EFFECT IN
BOTH HIGH AND LOW MOTOR
ACTIVATIONS.
YOU CAN SEE IN THIS ONE AND
THAT ONE, THE DIFFERENCE
BETWEEN THE TWO AND THE PF IS
MORE FREQUENCY DEPENDENT WITH
VARIATION.
SO WHEN YOU HAVE A GREATER
SENSORIMOTOR EFFECT WITH LFS
VERSUS THE GREATER LIMBIC
EFFECT WITH HFS, HOW DOES THIS
AFFECT THE PERI-ROLANDIC
NETWORK?
SO YOU CAN SEE BETWEEN THE
HIGH AND THE LOW FREQUENCY,
THE BLUE IS VERY DIFFERENT
WHILE THE RED IS WHERE MOST OF
THESE LOOK VERY SIMILAR.
SO IN SUMMARY, LOOKING AT
PATIENTS WITH PF VERSUS CN D
BS AND F MRI IS REALLY A
MARKER OF NEUROVASCULAR
RESPONSE SO YOU CANNOT EASILY
DETERMINE THE NET EFFECT OF
NEURONAL ACTIVITY.
SO FUTURE STUDIES INTEGRATING
ELECTROPHYSIOLOGY AND IN VIVO
EFFECTS OF D BS WILL HELP US
UNDERSTAND WHAT THE EFFECT
REALLY IS SO I WILL END THERE
AND ANSWER QUESTIONS.
[APPLAUSE]
>>THANK YOU SO MUCH, IS THERE
ANY QUESTIONS FROM THE
AUDIENCE?
OKAY, IF NOT, WE ARE RUNNING
OUT OF TIME SO THANK YOU AGAIN
AND MAYBE WE CAN MOVE FORWARD
WITH THE NEXT SPEAKER.
THE LAST SPEAKER OF THIS
SESSION IS Dr. CHOW, I HOPE
I PRONOUNCE THE NAME
CORRECTLY,.
>>THANK -- BIQI ZHAO.
>>IS HE THANK YOU FOR THE
INTRODUCTION, I HAVE SOME
DECLARATIONS.
THE BRAIN ACTIVITY RECORDING
ARE HIGH RESOLUTION AND WHOLE
BRAIN LEVEL, NONINVASIVE, HIGH
SPATIAL AND LOW SPATIAL
RESOLUTION.
SO PEOPLE HAVE BEEN LOOKING AT
THE POWER IMPLICATIONS ON THE
NODES.
THE CLASSES OF POWER AND DATA
LINK INCLUDE ELECTROMAGNETIC,
PIESOELECTRIC, NEAR INFRARED
AND BODY COUPLED.
HOWEVER, AS WE LOOK AT THE
IMPLANTATION DISTANCE, ALL OF
THESE SUFFER FROM POWER
DELIVERY AND RANGE DUE TO
ATTEN WAGES AND ALSO IF WAOUPT
TO RELATE TO IMPLANTS, WE WILL
HAVE DEVICE MANIPULATION.
SO WE PROPOSE A SOLUTION WITH
A SEPARATE POWER AND UPLINK.
WE FOCUSED ULTRASOUND AND
PROVIDE THE DOWN DATA LINK
WITH MRI.
WE CAN ACHIEVE THE
COMMUNICATION FROM DATA LINK
AND UPLINK.
WE CAN RECORD THE SIGNALS FROM
THEIMPLANTS FOR A SHORT PERIOD
OF TIME.
AFTER THAT, WE CAN STUDY THE D
BS ON PATIENTS OF INTEREST.
THEN WE RECORD THESE THROUGH
THE MRI SCAN.
IN PARTICULAR, WE'RE GOING TO
DO THIS BY MODULATING THE
SIGNAL INTENSITY ON AREAS OF
IMPLANT OVER TIME.
WE CAN THEN EXTRACT THE VISUAL
DATA SERIALLY AND RECORD THEM
BACK TO THE DATA RECORDED SO
WITH THIS WE CAN GET DIFFERENT
RATES OF ACTIVATION.
SO WE DO THIS A COUPLE OF
WAYS.
THE SIGNAL WILL BE RECEIVED
FROMULTRASOUND.
THEY WILL RECORD THE ACTIVITY
FOR SHORT PERIOD OF TIME AND
RECORD THE DATA ON THE DEVICE.
EVENTUALLY WHEN IT COMES TIME
TO EXPORT THE DATA OUT, WE
WILL ENCODE IT OVER TIME
THROUGH DYNAMIC MRI BY
MODULATING WITH A MICROCOIL.
SO WE ENVISION THIS DEVICE TO
BE IF 700UM, WE HAVE A CHIP
AND TINY DEVICE TO CONTROL THE
DATA.
NOW LET'S LOOK AT HOW WE USE
THIS TO RECORD THE
INFORMATION.
SO THIS WILL RECORD THE SIGNAL
AND IT WILL DROP THROUGH TIME.
IF WE PUT THE MICROCOIL INSIDE
THE VOXEL AND DRIVE CURRENT
THROUGH IT, IT WILL RECREATE A
MODEL ELECTRONIC FIELD.
THIS REDUCES THE SIGNAL
CREATING A CONTRAST IN THE
SIGNAL INTENSITY.
SO TO TRANSMIT ONE BIT DATA
FROM FRAME, WE CAN DRIVE
CURRENT THROUGH THE COIL WHEN
TRANSMITTING THE 1 AND NO
CURRENTS WHEN TRANSMITTING THE
0 IN THE SCAN.
HOWEVER, THE GRADE GRADIENT
ECHO EPI HAS TO COMPETE AND
THIS PRODUCES A LOW FNR.
HERE WE PREVENT THE COIL FROM
REFOCUSING.
SO WE TRANSMIT A SIGNAL
THROUGH THE COIL.
A COIL IS PLACED IN THE
PHANTOM AND POWERED BY A
NONMAGNETIC BATTERY.
IT IS PLACED IN A SHIELDED BOX
AND PLACED ON THE PATIENT'S
BED.
THE CONTROLLER RECEIVES A
SIGNAL FROM THE CONTROLLER
ROOM THROUGH A CABLE.
THE CABLE RECEIVES THE
IMPULSES AND THEN THE
MICROCONTROLLER NOTICES THE
SIGNAL AND CHANGES THE
DIRECTION IN THE COIL.
SO HERE WE SHOW THE RESULTS
WITH THE SAME CURRENT FLOWING
THROUGH THEM WITH DIFFERENT
ECHO TIMES.
IN THE PREVIOUS ECHO CASE,
BECAUSE OF THE WATER BASE, IT
MAKES IT DIFFICULT TO
DIFFERENTIATE THE CONTRAST
ACCESSIBILITY AND WE CAN SEE
THE CONTRAST ON THE LEFT.
THE SECOND TEST SHOWS THE
INTENSITY OF SIGNAL OVER TIME
AND AS WE DO THAT, WE GET A
LARGER SIGNAL OF CONTACT.
SO WE IMPROVED THIS IDEA USING
A CHIP WITH NANOTECHNOLOGY AS
STRIPED ABOVE.
SO WE ALSO AMENDED A RECOMMEND
FIRE AND DOWNLINK SYSTEM.
THIS CHIP IS CURRENTLY BEING
FABRICATED.
SO IN CONCLUSION, WE PROPOSE
WIRELESS DATA PLATFORM TO
IMPROVE BRAIN APPLICATION.
IT PROVIDES AN UPLINK DATA OF
MRI.
WE SUPPORT SAME MAIN CROSS
MULTIMODE COMMUNICATION IN THE
TYPE BRAIN.
WE WANT PROOF OF CONCEPT
DESIGN TESTED IN GE3T SCANNER
AND TAPED OUT INTEGRATION.
I WOULD LIKE TO THANK THOSE
WHO HELPED ME ON THE PROJECT.
[APPLAUSE]
>>VERY INTERESTING, I HAVE
ONE QUICK QUESTION.
HAVE YOU CHECKED THE ION STATE
OF THIS DEVICE IN 3T
SIMULATION?
>>SO WE HAVE NOT -- WE ARE
NOT GOING TO DO A SIMULATION
ON THE DEVICES.
WE HAVE EVALUATED THE SAFETY
OF THE COIL DURING THE DATA
TRANSMISSION SO THE FIELD THAT
IS CREATED IS NOT GOING TO
INDUCE ANY ADVERSE AFFECT.
WE HAVE ALSO STUDIED THE POWER
CONSUMPTION AND IT DOESN'T
CAUSE ANY FROM STIMULATION
WHEN EMPOWERING THE ULTRASOUND
BUT WE CAN REDUCE THE OPTION
POWER.
BUT AS FAR AS OUR SAFETY IS
CONCERNED BECAUSE THE DEVICES
ARELEFT WITH A MILLIMETER
INSIDE.
>>ANY OTHER QUESTIONS?
OKAY, THANK YOU SO MUCH FOR
YOUR QUESTIONS AND NOW WE CAN
ENTER THE SESSIONS.
THANK YOU.
>>WELCOME, EVERYBODY,
GOOD AFTERNOON.
SO I'M GOING TO START SESSION 7,
MY NAME IS LUCIESHESA, NAVARRO,
THEY WILL BE MODELING AND SAFETY
ISSUES OF MRI IN
NEUROMODDULATION AND OUR FIRST
SPEAKER WILL BE ANDY HUANG, FROM
SLOAN KETTERRING.
SO ANDY?
>>ALL RIGHT.
HELLO?
OKAY, GOOD AFTERNOON, EVERYONE.
THANKS FOR INVITING ME TO THIS
WONDERFUL EVENT.
AND I'M GOING TO TALK ABOUT THE
SOFTWARE I DEVELOPED OVER THE
YEARS CALLED ROAST, IT'S A FUNNY
NIEM AND I WILL SMAIN WHAT IT
MEANS.
AND ALSO I WILL TALK ABOUT THE
VALIDATION OF THIS SOFTWARE IN
COMPARISON WITH OTHER OPEN
SOURCE AND COMMERCIAL SOFTWARE
FOR CERTAINLY--CERTAINLY
LECTRICAL STIMULATION.
FIRST DISCLOSURE, THIS IS
AWARDED BY NIH GRAND AND SOTERIX
MEDICAL.
BECAUSE RECENTLY I DID THIS WHEN
I WAS AT SOTERIX, YEARS AGO
AFTER THAT I WENT TO MEMORIAL
SLOAN KETTERRING CENTER, AND
THAT RECENTLY I CHANGED MY JOB
BACK AGAIN TO SOTERIX SO I
DIDN'T HAVE A CHANCE TO UPDATE
THE PROGRAM BOOK.
SO FIRST BACKGROUND.
I THINK MOST OF YOU MUST HAVE
KNOWN THIS, ELECTRICAL
STIMULATION OR TS, TECHNIQUE TO
APPLY CURRENT ON THE SCALP TO
MODULATE THE BRAIN AND THERE'S A
LOT OF RESEARCH SHOWING THAT
THIS CAN IMPROVE COGNITIVE
FUNCTIONS AND ALSO EVEN TREAT
DECEASES, SO IN PRACTICE BECAUSE
WE DON'T--WE DON'T HAVE THE
ABILITY TO SEE OR VISUALIZE HOW
THE CURRENT FLOWS IN THE BRAIN
IN REALTIME SO WE WILL USE HEAVY
COMPUTATION MODELS TO PREVIEW
HOW THE ELECTRIC CURRENT WILL
FLOW UNDER
ELECTRO[INDISCERNIBLE].
SO HOW COULD WE GET THIS
COMPUTATIONAL MODEL?
WHEN I STARTED WORKING IN THIS
AREA, OVER A DECADE AGO, THERE
WAS A PROTOTYPE IN THE WORK FLOW
TO CONFRUCT THIS COMPUTATION
MODEL FROM A MAGNETIC RESONANCE
IMAGE, IT'S CALLED TES MODELING,
SO HOW DO WE GET THE MODEL ON
THE RIGHT SIDE?
ALL THE WAY FROM THE IMAGE, ON
THE LEFT SIDE.
AND SO, FIRST OF ALL WE HAVE TO
SEPARATE DIFFERENT TISSUES OUT
BECAUSE DIFFERENT TISSUE HAVE
DIFFERENT ELECTRICAL
CONNECTIVITYS, SO WE WANT TO
ASSIGN DIFFERENT CONNECTIVITYS
TO DIFFERENT TISSUES THAT WE
CAN'T CAPTURE THROUGH THE
ELECTRICAL FIELD BASED ON THESE
CONNECTIVITYVILLEUES.
SO THIS IS CALLED IMAGE
[INDISCERNIBLE] SO WE USE SPM,
TO THIS SEGMENTATION, AND AFTER
THAT, THE SECOND STATE IS TO
PLACE VIRTUAL ELECTRODES ON THE
SCALP AND WE WANT TO
[INDISCERNIBLE] THIS ENTIRE
VOLUME INTO ELEMENTS SO THAT THE
COMPUTER CALCULATES THE
CERTAINLY--CERTAINLY LECT ROUGH
ATOM FIELD AND THIS NUMERICAL
TECHNIQUE IS CALLED
[INDISCERNIBLE] AND WE USED TO
USE THE COMMERCIAL SOFTWARE
CALLED SIMPLE WARE TO DO THIS
MESH AND ONCE WE HAVE THE MESH,
WE USE ANOTHER SOFTWARE ABACUS
TO CALCULATE UNDERLYING PHYSICS
FOR CURRENT ELECTRICAL
STIMULATION BECAUSE IT'S CURRENT
AND IT'S BELOW A HUNDRED HERTZ
SO AUTOIT IS EFAIGZS SO WE USE
ABACUS TO SOLVE THIS EQUATIONS
TO GET THE ELECTRICAL FIELD
DISTRIBUTION.
SO THIS IS A LONG WAY AND QUITE
COMPLICATED WITH AT LEAST 3
MAJOR SOFTWARE INVOLVED WITH A
LOT OF DIFFERENT ELEMENTS.
AND WITH EACH STATE, WE NEED A
LOT OF MANUEL LABOR TO CONVERT
AND IMPART INTO DIFFERENT
SOFTWARE AND INTERFACE DIFFERENT
SOFTWARE.
SO IT'S VERY LONG AND SLOW AND
NEEDUOUS AND ABOUT THAT TIME IT
TOOK 2 WEEKS TO BUILD 1 MODEL.
SO I SPENT MY Ph.D. AND SOME
OF MY POST DOC TIME TO TRY TO
AUTOMATE THE ENTIRE WORK FLOW.
AND YEARS LATER, I RELEASED
THOSE AND THIS ENTIRE PROCESS IS
FULLY AUTOMATED WITH A SINGLE
PACKAGE AND WITH OTHER MAJOR
STEPS USING OPEN SOURCE SOFTWARE
AND THE ONLY COMMERCIAL THING
YOU NEED IS A [INDISCERNIBLE]
LICENSE AND SO GO TO THE WEBSITE
AND DOWNLOAD THIS PACKAGE AND
THEN YOU OPEN IT UP AND JUST
TYPE 1 SINGLE LINE OF COMMENT
AND YOU WAIT FOR LIKE 20 MINUTES
CAN YOU GET THE ELECTROFIELD,
THE MODEL FROM THE ELECTROFIELD
FROM THE MR IMAGE.
AND IT'S--IT'S FREE AND FULLY
AUTOMATED AND SUPER EASY TO USE.
AND I CAN SHOW YOU SOME EXAMPLE
USAGE OF THIS SOFTWARE, LIKE THE
FIRST 1 IS A BASIC SIMULATION,
SO RIGHT HERE I'M SHOWING THIS
EXAMPLE, WE ARE TRYING TO
STIMULATE AN ELECTRICAL FIELD ON
THIS SUBJECT 1 UNDER THE
EXAMPLE.
WE ARE TRYING TO ASK THOSE TO
CALCULATE ELECTRICAL FIELD ON
THIS ELECTRICAL MONTAGE.
WE WANT TO INJECT
[INDISCERNIBLE] FOLLOWING THE
INTERNATIONAL SYSTEM AND .7
[INDISCERNIBLE] AT P2 AND WE
WANT THEM AT .6 MILLI AMP GOING
OUT AND THAT'S WITH 02 AND IT
WOULD GIVE YOU THE SIMULATION
TAG AND ONCE WE ENTER THIS, IT
WILL GENERATE THE MODEL OF THE
ELECTROFIELD FULLY AUTOMIGHTED
IN 15-20 MINUTES.
AND IF YOU DO WANT TO DO
SOMETHING FANCY LIKE TARGETED
STIMULATION, MEANING LIKE IF YOU
WANT TO TARGET SOME AREA, SAY,
THE MODEL [INDISCERNIBLE] AND
YOU WANT TO PRESS IT ON THE
SKULL SO THAT IT ACTUALLY, THE
CURRENT WILL TARGET THE MOTOR
CORTEX WITH THE HIGHEST POSSIBLE
INTENSITY, YOU NEED TO DO THIS
IN 2 STEPS, THE FIRST 1 YOU JUST
GENERATE THE LIT FIELD, LIT
FIELD IS SAY FANCY TERM FOR DATA
THAT NEEDED TO DO THIS TARGETED
STIMULATION.
SO ROAST, IN THE SAME SYNTAX YOU
TELL THOSE IN THE FIELD, ONCE
THIS IS DONE YOU DO DOSE TARGET.
YOU GIVE IT THE SAME MI DATA AND
THEN, YOU JUST TELL THOSE TOW
THAT THE LABEL OF THE LEAD FIELD
DATA AND YOU TELL THOSE TARGETS,
THE EXACT LOCATION WHERE WHERE
YOU WANT IT TO TARGET AND HERE
THIS IS, I BELIEVE THIS IS MRI
COORDINATES OF THE MODEL CURRENT
AND THEN YOU GIVE IT A
SIMULATION TAG.
SO THIS WILL HIT THE MODEL WITH
THE HIGHEST POSSIBLE INTENSITY.
SO EVERYTHING IS SIMPLE AND EASY
TO USE AND RIGHT NOW, ROAST IS
LIKE 5 YEARS OLD AND WE DID A
REVIEW OF THE USAGE AND
ADOPTIONS OF ROAST THIS YEAR AND
WE FOUND THAT IT'S BECOMING
POPULAR AND JUST LIKE SOME OF
THE USERS DOWNLOAD THIS
BASICALLY IT HAS BEEN ADOPTED
ALL OVER THE WORLD AND WE ALL
REVIEWED ALL THE ARTICLES THAT
ALL THE PUBLICATIONS THAT CITED
THOSE, WE REVEAL OF COURSE 125
ARTICLES, WE FOUND 94
PUBLICATIONS THAT BASICALLY,
THEY ARE ALL CLINICAL STUDIES
THAT USE THOSE TO BUILD
COMPUTATIONAL MODELS FOR THEM.
AND OUR OUR SURPRISE THERE, WE
FOUND THERE ARE OVER 800
INDIVIDUAL HEADS MODELED OVER 30
CLINICAL APPLICATIONS, SO THIS
MEANS THAT IF THERE WERE NO
ROAST, IT WOULD HAVE COST AT
LEAST 1800 WEEKS OR ROUGHLY 30
YEARS TO BUILD ALL THIS, FOR THE
TIME THAT'S SAVED, IT'S A LOT,
RIGHT NOW IT ONLY TAKES 800
TIMES 20 MINUTES, SOMETHING LIKE
THAT AND WE ALSO FOUND THAT VERY
SIMILAR ELECTROFIELD INTENSITY
HAVE FOUND BECAUSE OF THESE
DIFFERENT STUDIES AT THE SAME
BRAIN REGIONS, UNDER THE SAME OR
SIMILAR ELECTROMONTAGES.
SO YEAH, I'VE BEEN TALKING A LOT
ABOUT ROAST, SO KREBS CYCLE
ROAST SO THIS IS THE FULL NAME
OF ROAST, IT'S A LONG TIME BUT
THE KEY WORDS ARE THE FIRST 2
REALISTIC AND VOLUMEET RICK SO
LET ME TALK ABOUT THESE 2 KEY
WORDS AND WHAT THEY MEAN.
SO 1 MATRIX, SO I HAVE TO
INTRODUCE SOME HISTORY ABOUT
THIS MODELING FOR THE ELECTRICAL
STIMULATION.
WHEN I JUST STARTED WORKING IN
THIS AREA, THERE WAS ALREADY AN
OPEN SOURCE PACKAGE CALLED
SIMNIBS DEVELOPED BY DR. AXLE
THIELSCHER AND HIS GROUP.
I REMEMBER AT THAT TIME, THEY
CLAIM IT'S FULLY AUTOMATED.
I REMEMBER THERE ARE 2 STEPS,
THE FIRST STEP IS YOU ENTER 1
COMMENT, SO WE CAN GET A SECOND
COMMENT FOR THE IMAGE AND THEN
YOU ENTER A SECOND COMMENT TO
GET THE DISTRIBUTION.
YEAH, CORRECTORY IF I'M WRONG.
AND AT THAT TIME, THIS ENTIRE
PATTERN IS BASED ON ALL SOFTWARE
AND THE SEGMENTATION PART THEY
REUSE FOR FSL, THE STIMULATION
INSIDE THESE SOFTWARE IS BASED
ON A SO CALLED SURFACE APPROACH.
THE IDEA IS THORS GROW A POINT
INSIDE THE BRAIN TO MATCH THE
CORTICALE SURFACE OF THE BRAIN.
AND IT CAN TAKE UP TO 8 OR 9
HOURS TO CALCULATE A SINGLE
HEAD.
SO, AT THAT TIME WEB CONNECTED
USE SPM AND THIS BEHIND IT IS
BASED ON CLASSIC AVAILABILITY
INFERENCE APPROACH WHICH IS
BASED ON THE VOXEL VARIABLE AND
THE PROFILE OF THE INTENSITY FOR
DISTRIBUTION.
SO THAT'S COMPUTATIONALLY
INTENSIVE SO IT'S MUCH FASTER SO
SPM TAKES ABOUT 10, AT MOST 10
MINUTES TO RUN FOR A SINGLE
HEAD.
BECAUSE THE [INDISCERNIBLE] ON
THIS VOLUMEETIC APPROACH, THAT'S
WHY I USE VOLUMETRIC IN THE NAME
OF ROAST, AND ALSO THE SECOND
VERSION OF SIMNIBS, ALSO ADOPTED
THE SECOND IMAGING AND ROAST AND
SIMNIB SYSTEM ALMOST THE SAME IN
TERMS OF THE PACKAGE THEY
UTILIZE.
EXCEPT WHAT DIFFERS IS THE
SECOND PATIENT DETAILS.
SO HERE I'M SHOWING THE
SEGMENTATION DATA IN THE MIDDLE
OF THE PIPELINE IN BOTH OF THOSE
AND SIMNIBS AND IF WE VISUALIZE
THE--SO HERE'S THE SECOND IMAGE
OF THE SKULL, YOU VISUALIZE THE
SKULLS, WE FOUND THAT THE THIS
IS CONTAINED FROM SPM AND
MODELED BY THE VOLUME BETWEEN 2
LAYERS AND YOU CAN SEE HERE, WE
CAN SEE CLEARLY 2 LAYS AND ALSO
YOU CAN SEE THE OPENINGOT SKULL.
FOR EXAMPLE, THE OPENING GOES
THROUGH AND YOU ALSO NEUTRALIZE
THE SECOND FSL, YOU CAN ONLY SEE
A SINGLE LAYER AND IT'S
COMPLETELY CLOSED.
SO BASICALLY, YOU COMPARE THE
SEGMENTATION FROM SKULL,
SECONDLY FROM SPM IS MORE
REALISTIC THAN FROM FSL.
AND ALSO INTERESTINGLY, IF YOU
VISUALIZE THE SAME SEGMENTATION,
FOR IN THE MIDDLE OF SIMNIBS,
YOU ALSO SEE A SINGER LAYER AND
IT'S ALSO CLOSED.
I'M NOT SURE IF THIS IS THE
SKILL THAT'S CATCHING THE LATEST
SIMNIBS BUT IT'S NOT SOMETHING I
FULLY UNDERSTAND WHY, IT'S FULLY
CLOSED SO IN THAT SENSE, I
REALIZE THE SIMULATION ROAST IS
MORE REALISTIC AND THAT'S WHY I
CALL IT REALISTIC IN THE NAME.
BUT DO ALL THESE DETAILS MATTER?
SO HERE I'M COMPARING THE FINAL
COMPUTED ELECTROFIELD BETWEEN
ALL THESE SOFTWARE.
SEE ON THE LEFT SIDE, YOU FORM
NUMBER 1 TO NUMBER 4.
SO THAT'S ROAST AND IT'S
DIFFERENT VARIANTS AND HERE, AND
BASICALLY JUST THE REPLACING THE
OPEN SOURCE PACKAGES WITH
COMMERCIAL SOFTWARE AND WE DON'T
SEE MUCH DIFFERENCE IF WE
COMPARE ROAST AND IT'S VARIANTS
AND WE ALSO DON'T SEE MUCH
DIFFERENCE FOR DIFFERENT
VERSIONS OF SIERK MNIBS, BUT
WHEN WE COMPARE THOSE IN SIMNIBS
WE SEE A RELATIVELY HIGHER
DIFFERENCE AND WE COULD EXPLAIN
THIS AS THE DETAILS OF
COMPUTATION IN THE SKULL FOR
EXAMPLE, BUT THESE ARE ALL JUST
COMPUTED IN COMPUTATIONAL MODELS
SO WE STILL DON'T KNOW IF
THE--HITTING THIS UNLESS WE
RECORD IT AFTER THESE.
SO WE HAVE TO COMPARE IT WITH
THE ACCURATE RECORDINGS AND
LUCKILY WE HAD THE DETAILSA FROM
THE INTRA CRANIAL RECORDINGS
FROM THE PATIENTS.
SO HERE WE ARE WORKING WITH NYU
SCHOOL OF MEDICINE AND THEY HAVE
ACCESS TO OVER 10 PATIENTS,
PATIENTS UNDER THE INTERCRANIAL
EEG MONITORING AND FOR EACH
PATIENT THERE ARE OVER A HUNDRED
CRANIAL ELECTRODES IMPLANTED SO
WE JUST APPLY THE ELECTRICAL
STIMULATION AND THEN WE DO THE
RECORDING AT THE SAME TIME.
I HAVE A VIDEO, I WANT TO SHOW
THE VIDEO BUT IT'S NOT WORKING
FOR SOME REASON HERE.
SO BASICALLY THIS IS A THE
RECORDING AND THE MODEL FROM THE
FIRST SUBJECT AND AS CAN YOU
SEE, SO BASICALLY EACH SINGLE
DOT REFERENCE 1 SINGLE
CERTAINLY--CERTAINLY LECT RODE
AND WE CAN SEE THAT THE
RECORDING AND THE MODEL, THEY
CORRELATE PRETTY WELL WITH THE
ELECTROFIELD AND THE MODEL
OVERESTIMATE A LITTLE BIT OF THE
RECORDINGS FOR BOTH THE VOLTAGE
AND THE ELECTRICAL FIELD.
SO THIS TELLS US THAT THE
PATIENT MOLL MODELS ARE DOING A
PRETTY GOOD JOB IN PREDICTING
THE ELECTROFIELD AND ALSO THE
EXTRA FIELD IS CALCULATED HERE
ONLY ALONG THE RECORDING, THE
ACTUAL LIKE, AS YOU CAN SEE,
THIS SCREEN STRIP HERE AND THIS
IS THE FIRST TIME VALIDATION OF
THE TS MODEL SO WITH THIS
RECARDING WE CAN ASK WHICH IS
HORMONE ACCURATE FOR THOSE
SIMULATORS AND IT TURNS OUT
THEY'RE PRETTY MUCH THE SAME,
THERE'S NO SIGNIFICANT
DIFFERENCE BASED ON THIS
RECORDED DATA.
SO I THINK I'M RUNNING OUT OF
TIME, SO THE FUTURE DIRECTION OF
ROAST IS TO ADD MORE FEATURES,
SO THAT USERS CAN ENTER THE
INTEREST OF [INDISCERNIBLE] TO
RESPOND WITH [INDISCERNIBLE] AND
WE WANT TO OPEN WITH OPEN SOURCE
SOFTWARE SUCH AS BRAINSTORM FOR
SOURCE LOCALIZATION AND WE ALSO
WANT TO COMBINE WITH FREE SURFER
BECAUSE THERE ARE ADVANTAGE OF
SURFACE APPROACH TO MODEL THE
DETAILED GYRATION OF THE
[INDISCERNIBLE].
AND WE ALSO WANT TO INTERFACE TO
ALLOW USERS TO INCORPORATE THEIR
CUSTOMIZED VERSION OF
SEGMENTATION AND ALSO, TO AT THE
DEEP LEARNING, ANSWER FOR
SEGMENTING HEADS WITH LIKE
LESIONS OR OTHER PATHOLOGIES.
WE ALSO WANT TO ADD A FEATURE OF
PLATFORM SOFTWARE SO USERS CAN
CALIBRATE THE ACTIVITY DOWN TO
YOUR ACTUAL RECORDINGS SAY LIKE
INTRA CRANE RECORDINGS OR EVEN
THE CURRENT AND DENSITY MAPPING
AS WELL WE DISCUSS THIS MORNING.
AND HERE ARE SOME RESOURCES
ABOUT THIS SOFTWARE, THE CODE,
THE DOCUMENTATION AND JUST
[INDISCERNIBLE] AND REALLY
[INDISCERNIBLE].
SO I'M HOPE TO TAKE QUESTIONS
BUT I DON'T THINK I HAVE TIME.
>>YOU DO, YOU DO.
>>IS THERE ANY QUESTIONS?
>>[ APPLAUSE ]
>>IF THERE ANY QUESTIONS?
IT'S OPEN TO QUESTIONS, YEAH?
>>SO THANK YOU VERY MUCH FOR
THE OPEN SOURCE ROAST, I AM ALSO
USING IT SO I WILL PRESENTING IT
IN A FEW MINUTES.
MY QUESTION IS ROAST USERS NIFT
INPUTS FOR IMAGE FOR
SEGMENTATION PURPOSES OR FOR
MULTIPLE COMBINATION OF
DIFFERENT ANATOPICAL IMAGE SO
HOW THE PERFORMANCE OF NIFT THE
FILES EFFECTS THE PERFORMANCE OF
ROAST.
SO DO WE HAVE ANY COMMENTS ON OR
EXPERIENCE FOR EXAMPLE, IF YOU
USE [INDISCERNIBLE] IMAGE FOR
SEGMENTATION WITH NIFTY CROSS
FIELD TRANSSTATE ALL THESE MAPS
TO REALISTIC MODELS MORE EASILY
OR IF YOU USE ANOTHER KIND OF MR
IMAGE THEN THE NIFTs, WILL
GENERATED RETIRED BETTER ROAST
SO DO YOU HAVE ANY EXPERIENCE ON
THE MRI INPUT REQUIREMENTS?
>>ARE YOU ASKING ABOUT INPUT P1
ONLY OR T1 AND T2, WHICH 1 IS
BETTER?
>>YES, FOR EXAMPLE.
>>BASED ON MY EXPERIENCE, T1 IS
GOOD ENOUGH, BESIDES T1 HAS 1
MILLIMETER RESOLUTION AND NO
ARTIFACTS OR ANY BIOSPHERE OR
LIKE DISTORTION.
AS FAR AS I KNOW, IF YOU ADD T2,
THAT HELPS A LITTLE BIT BUT NOT
THAT MUCH, NOT SIGNIFICANTLY.
>>THANK YOU.
>>ANY OTHER QUESTIONS FROM THE
AUDIENCE?
I DO HAVE A QUESTION.
O DO YOU USE OR THE PAPERS THAT
YOU SHOWED, DO THEY USE IT IN A
CLINICAL SETTINGS, DID THEY USE
IT TO DETERMINE WHERE TO PUT THE
ELECTRODES OR IS THIS THE WAY
THEY ARE USING IT?
>>YOU MEAN IN THE--IN THE
ACTUAL RECORDING?
>>NO, WHAT I MEAN IS YOU SAID
THERE WERE PAPERS THAT USE YOUR
METHODS TO THE CLINICAL SETTING,
DO THEY USE IT TO DETERMINE
WHERE TO PUT THE ELECTRODES?
>>NO, I THINK MOST OF THE
PAPER, THE ONLY USE THE BASIC
VERSION OF ROAST, SO THEY KNOW
WHERE TO PLACE THE ELECTRODES,
THEY JUST WANT TO KNOW THE EXTRA
FIELD.
>>SO IT'S MORE POST ANALYSIS.
>>RIGHT.
I DON'T THINK ANY PAPER HAS USED
THE TARGET FEATURE OF ROAST.
>>OKAY.
>>YEAH,.
>>THANK YOU.
THANK YOU.
>>SO NOW WE WILL--THANK YOU FOR
YOUR PRESENTATION AGAIN, AND WE
ARE GOING TO SPAP NOW SPEEMERS
IF YOU DON'T MIND BECAUSE I
TALKED YESTERDAY WITH
[INDISCERNIBLE] AND OLA AND THEY
WANTED FOR THE SAKE OF INTEREST,
TO SWAP THE PRESENTATIONS SO
FIRST WE WILL ON OULA, PUONTI,
AND HE WILL TALK ABOUT SIM NIBS,
SORRY, I ALSO SAY IT WRONG, AND
IT'S WRONG IN THE PROGRAM, SO
SORRY ABOUT THAT.
I HOPE EVERYTHING IS READY NOW,
YEAH?
>>ALL RIGHT, YEAH, SO I AM
GOING TO TALK ABOUT THE OTHER
SIMULATION TOOL CALLS SIM NIBS
SO FOR THE FAST FEW YEARS WE
WORKED HARD TO UPDATE TO THE NEW
VERSION AND SO I WILL GIVE YOU A
LITTLE BIT OF A TOUR ON THE NEW
FEATURES WE ADDED AND THE
STIMULATION.
I WON'T GO INTO TECHNICAL
DETAILS BUT I'M HAPPY TO
[INDISCERNIBLE] IN MORE DETAIL.
--ALL RIGHT.
SO ANDY ALSO SHOWED
THIS--SORRY--ELECTRICAL
STIMULATION PIPELINE SO WE
USUALLY START OUT WITH THE
IMAGES OF T1, T2, AND THE FIRST
TO DO SEGMENTATION AND ARE AFTER
THAT YOU DERIVE THAT AND SIGN
CONNECTIVITY ISSUES, THIS IS THE
SAME WORK FOR SIM NIBS AND ONCE
YOU HAVE THE FINITE
CONNECTIVITY, YOU CAN START
DOING ELECTRICAL FIELD
STIMULATIONS.
SO HERE I'M JUST SHOWING THE
MONTAGE WHERE YOU PUSH IN THE
CURRENT FROM THE ELECTRODE AND
YOU TAKE IT OUT THROUGH THE
ELECTRODES, NOW YOU HAVE AN
ELECTRIC FIELD VECTORING EACH
ELEMENT OF THIS MESH.
AND THEN YOU CAN INTERKD--SALLY
THESE VALUES TO DIFFERENT SPACES
SO YOU CAN INTERPPOETICALATE IT
TO THE NORMAL CENTERS IF YOU
WANT TO LOOK AT NORMAL COMPONENT
OR CENTRAL COMPONENT OF THE
ELECTRICAL FIELD OR PUT
APPROXIMATE BACK TO THE ORIGINAL
VOLUNTEERSUMENT.
VOLUNTEERSUMENT--VOLUME.
YOU CAN ALSO LIKE WITH THE
AVERAGE IF YOU WANT TO DO BROAD
BASED ANALYSIS OR LOOK AT THE
ELECTROFIELD OF THE GROUP OF
SUBJECTS OR AT ELECTRIC FIELD
THROUGH THE MNI TEMPLATE IF
YOU'RE USING A METRIC ANALYSIS.
SO AS ANDY SAID, WE USED THIS TO
DO SEGMENTATION, WE'VE SINCE
WITH THE SEGMENTATION PIPELINE
TO ADD MORE TISSUES AND
HOPEFULLY SORT OF BE A BIT MORE
ACCURATE IN THAT SENSE.
SO HERE YOU CAN ALREADY SEE THAT
WE'VE ADDED SORT OF THE
COMPARTMENT, THE COMPACT, NOW OF
THINGS AND HARVESTING DIFFERENT
TISSUE SO I WILL TALK ABOUT HOW
THIS SEGMENTATION WORKS WITH SIM
NIBS NOW.
SO THE FIRST THING WE DID WAS
TO,A QUIRE TRAINING DATA,
BECAUSE WE WANTED TO ADD MORE
TISSUES.
SO WE ACQUIRED A DAT SET OF 20
SUBJECTS WHERE THE AGE RANGES
FROM 20 YEAR-OLDS TO 50
YEAR-OLDS, IT'S AN EVENT SPLIT
BETWEEN MALES AND FEMALES AND WE
ALSO HAVE SUBJECTS SO WE SHOULD
HAVE A GOOD VARIATION OF THE
HEAD ANATOMY AND THIS DATA SET.
AND THE SUBJECTS WENT THROUGH
QUITE A LOT OF SCANS SO WE HAD
THE STANDARD MR SCANS T1, T2.
WE HAVE MD DIXON BORDER SCAN,
PET SCAN AND CT AND ALSO
[INDISCERNIBLE].
SO THE IDEA WAS TO,A WIRE A
DIFFERENT CONTRAST, DIFFERENT
INTERESTS SO WE CAN SEE ALL THE
TISSUES WE'RE INTERESTED IN.
WE THEN SHIFTED THIS ON THESE
SCANS SO NOW WE HAVE TISSUES
LIKE THE SPINE, THE VISUAL
NERVE, EYEBALLS, EYE MUSCLES,
ARTERIES AND VEINS, CSF AND THE
[INDISCERNIBLE] AND THE BONUS IN
BETWEEN AND THE SOFTTISSUE
OUTSIDE OF THE HEAD AND FROM
THEZ TRAINING DATA WE GENERATE A
NEW TISSUE ATLAS WHICH WE USE
FOR SEGMENTATION.
SO SENSE THEN WE'VE ADDED MORE
DETAIL ON THE BRAIN SIDE SO
THESE ARE ANATOMICAL
SEGMENTATIONS MANUELLY DONE FROM
40 DIFFERENT STRUCTURES IN THE
HEAD.
THESE ARE THE SAME SEGMENTATION
THERE USED TO TRAIN THE ATLAS SO
WE NOW HAVE HIPPOCAMPUS,
THALAMUS AND SO FORTH.
AND WE TOOK THIS BRAIN
SEGMENTATIONS AND PUT THEM
TOGETHER WITH THE HEAD
SEGMENTATIONS WE HAD PREVIOUSLY
AND WE CAN AUTOMATICALLY SEGMENT
QUITE A FEW STRUCTURES FROM A
T1, TO T2, AND WE DON'T OF
COURSE USE ALL THESE STRUCTURES
IN THE SIMULATIONS BECAUSE MANY
OF THE STRUCTURES LIKELY HAVE
SIMILAR ELECTRIC CONNECTIVITYS
BUT THIS IS OUT WITH THESE
SEGMENTATION METHODS AS WELL SO
IT'S INTERESTING, THE
CORRELATING [INDISCERNIBLE] WITH
THE MAGNETIC FIELD, WE CAN DO
THAT.
SO, AS SBM, THIS NEW
SEGMENTATION METHOD, WE HAVEN'T
SEEN THIS, SO WE CAN USE A T1
INPUT.
YOU CAN USE A T1, T2 INPUT, YOU
CAN EVEN USE A CT, IF YOU SORT
OF MORE INTERESTED IN THE SKULL
AND COMBINING THAT WITH THE T1,
YOU WOULD GET BRAIN CONTRAST AND
ALSO SKULL CONTRAST.
IF YOU DON'T HAVE T1, YOU CAN
PUT IT T2 MAYBE NOT THE MOST
OPTIMAL SITUATION BUT YOU CAN DO
IT, YOU CAN ALSO SEE THE BRAIN
CONTRAST HERE, NOT SO GOOD BUT
IF YOU WANT TO MORPHOLOGICALLY
QUANTIFY THE SKULL SHAPES, IT
MIGHT BE AN IDEA.
SO I HAVE A LITTLE BIT OF A
DIFFERENT TAKE ON THE T1, T2
THING.
SO EVEN THOUGH CAN YOU PUSH
THESE SCANS THROUGH THE
SEGMENTATION AND GET A
SEGMENTATION OUT, THE IS SORT OF
OLD ADAGE OF TRASH IN TRASH OUT
STILL APPLIES SO MAKE SURE YOUR
INPUT SCANS ARE GOOD.
SO HERE I'M SHOWING A RESFERENCE
SEGMENTATION FROM THE CANNED
WHAT FOUNDATION AND I CREATED
THE HEAD MOLD FROM THIS
SEGMENTATION AND RAN A STANDARD
TDCS SIMULATION ON THIS AND
HERE'S HOW THE MAGNITUDE OF THE
FIELD ON THE CORTEX LOOKS LIKE.
I THEN RAN THIS USING A
SEGMENTATION WHICH IS JUST A T1
INPUT AND IF YOU VISUALLY LOOK
AT THIS SEGMENTATION, IT LOOKS
OKAY, THERE'S NO CLEAR
DEVIATIONS FROM THE ANATOMICS
SHOWN ON THE MR SCAN, BUT IF YOU
LOOK AT THIS IN A BIT MORE
DETAIL, THE WAY THIS PARAMETERS
AT THE MR SCANNER IS SET UP, WE
HAVE THIS BATCH OF ARTIFACTS SO
THIS BROAD LAYER HERE SHOULD BE
A BIT HIGHER HERE WHICH MAKES
THE SKULL LOOK THINNER THAN IT
IS IN ACTUALITY.
SO HERE IN RED, I'M SHOWING THE
TISSUE BORDERS FROM THE
REFERENCE SEGMENTATION, AND I'M
SHOWING THE TISSUE OF COURSE FOR
THE ULTIMATE SEGMENTATION, SO WE
HAVE A BIT OF AN UNDERESTIMATION
OF THE SKULL THICKNESS HERE AND
THAT RESULTS IN 30% DIFFERENCE
IN THE ELECTED FIELD MAGNITUDE
COMPARED TO THE REFERENCE
SIMULATION, IF YOU ADD T2
BECAUSE OF CSF LINES UP, YOU CAN
SEE THE INNER SKULL BETTER, YOU
CAN GETTER ESTIMATION OF THE
SKULL THICKNESS AND YOU REDUCE
THIS DIFFERENCE A BIT.
SO WE HAVE RECOMMENDATION ON THE
SIM NIB WEBSITE ON HOW TO SET
THESE UP SO YOU SHOULD KEEP IN
MIND THAT INPUT DATA MATTERS
HERE, JUST DON'T USE IT
PLIENDLY.
AND ANDY ALSO MENTIONED THAT WE
USE THE SURFACE BASED MESHING
AND IT WAS PROHIBITED ESPECIALLY
NOW THAT WE ADDED MORE TISSUE,
PREVIOUSLY WE HAD TO NEST THE
TISSUES, SO THAT GREAT MATTER
AND WHITE MATTER WERE WITH THE
CSF AND THEY WOULD FILL IN THE
SURFACES WITH THESE VOLUME
ELEMENTS AND NOW THAT WE HAVE
TISSUES THAT BECOME PROBLEMATIC
BECAUSE WE UPDATE THIS NEOF THED
HIERARCHY, SO WE ALSO MOVE TO
VOLUME BASED MESHING CANNED
WHAT.
WE DO SOME FREE PROCESSING TO
MAKE SURE THE OUTPUT MEASURES
ARE GOOD, SO WE FIRST UPSAMPLE
THE TISSUE LABELING TO DOUBLE
THE RESOLUTION OF THE SCAN TO,A
VOID STAIR CASING ISSUES, AND
THEN WE ALSO DO MORPH LOGICAL
OPERATIONS TO CLEAN THE
SEGMENTATION, SO HERE'S THE RAW
INPUT ON HERE AND HERE'S THE
CLEAN 1.
IT DOESN'T REALLY SHOW--YOU
DON'T SEE THE DIFFERENCE IN
THOSE BUT IF I SORT OF SWITCH
AROUND HERE, CAN YOU SEE THAT WE
OPEN UP THE [INDISCERNIBLE] AND
LOOKS LIKE THEY'RE STICKING
TOGETHER SO WE TRY TO OPEN UP TO
MAKE IT MORE BETTER FOR THE
ANATOMY AND ALSO REMOVE NOISY
BITS OF THE SEGMENTATION IF
THERE'S SOME SMALL LABELING
ERRORS.
THEN WE PUT THAT TISSUE LABELING
INTO THE MESHING, WE SEE MESHING
TOOLS HERE, 1 THING I WOULD LIKE
TO JUST MENTION IS THAT THIS
ALLOWS US TO USE SIZING FIELDS
SO WE CAN ADAPTIVELY CHANGE THE
SIZE OF THE MESH LET'S SAY ON
TISSUE THICKNESS SORE HERE IN
THE NECK WE HAVE A LOT OF SCALP
TISSUE SO WE CAN USE LARGER
ELEMENTS THERE AND THEN WHEN YOU
GO TO THINNER TISSUES, WE USE
MORE [INDISCERNIBLE] TO
STIMULATE MORE ACCURATELY.
THE ROLL OUT FROM SEEINGLE WAS
NOT NICE WE FOUND OUT SO IF YOU
LOOK AT THE SURFACE IT'S FAIRLY
SPIKING, I'M ALSO SHOWING
SURFACE HERE SO THESE SPIKE FIST
DO YOU SIMULATIONS IN THIS KIND
OF MESH YOU WOULD GET THIS HIGH
EFIELD VALUES.
SO WE CLEAN THAT OUT TO MAKE THE
MESHES NICER AND SMOOTHER AND
BETTER SUITED FOR SIMULATION.
THE OTHER ADDED BENEFIT FOR
DOING VOLUME BASED SEGMENTATION
IS PREVIOUSLY THEY WANT US TO
INTERACT WITH THE SEGMENTATION
AND THE MESH IS QUITE HARD IN
IMAGE 3.
SO LET'S SAY HAVE YOU SUBJECTS
OR PASHTS WITH PATHOLOGIES SUCH
AS TUMORS OR LESIONS AND YOU
WANT TO EDIT CERTAIN REGION IN
THE BRAIN SCAN.
IT WAS QUITE DIFFICULT.
NOW YOU CAN DO MANUEL EDIT, AND
I'M THINKING YOU CAN REALIGN THE
MESHING TO GET THOSE INTO THE
MESH SO THAT'S QUITE NICE.
IF YOU HAVE OTHER SEGMENTATIONS
OF ANIMALS OR EVEN FANDOMS, YOU
CAN USE THE MESHING PIPELINE TO
PUT THOSE WELL AND GET THE
MEASURES OF LET'S SAY MA
CABBINGS OR RATS WE DON'T HAVE A
SECOND PLATFORM FOR ANIMALS
ABOUT YOU YOU CAN USE IT TO DO
A--CREATE MEASURES.
ONCE QUIEWF DONE THE
SEGMENTATION, YOU'VE DONE THE
MESHING, YOU GET TO THE
SIMULATION PART WHICH MAY BE THE
MOST INTERESTING PART FOR MOST
OF YOU.
SO YOU CAN DO SIMULATION OF THE
TES, THERE'S CENTERS AROUND
BRAIN MONTAGE FOR EXAMPLE, IS
TMS AS WELL, THERE'S AN EXAMPLE
OF SIMULATION OF THAT MOTOR
CORTEX STIMULATION.
I WILL JUST SHOW THIS VIDEO
QUICKLY OF HOW TO SET UP, SO YOU
CAN USE A GUI BASED WAY OF
SETTING UP THE BASED SIMULATION
SO YOU LOAD IN THE HEAD MODEL
AND CHOOSE DIFFERENT LOCATIONS
TO SET UP YOUR TEST ELECTRODES
AND YOU CAN CHANGE THE SHAPE AND
THINGS, I AM PLAYING THIS AT 3
TIMES THE SPEED SO IT DOESN'T
TAKE 5 MINUTES BUT CAN YOU LOOK
AT THE LOOP AND YOU CAN SET UP A
TMS IMPEDIMENTSULATION IF YOU
WANT TO AND PRESS ROWN.
IT WILL RUN IT, IT TAKES A BIT
OF TIME, IF YOU DON'T WANT TO
USE THE GUI AND YOU HAVE A LOT
OF SUBJEKS CAN YOU ALSO INTERACT
WITH SIM NIBS AND USING STRIPS
THIS OUR MAT LAB, IT IS A STAND
OWN SO YOU DON'T EACH
[INDISCERNIBLE] OR SBM, BUT CAN
YOU STILL DO SCRIPTING IN MAT
LAB IF YOU'RE MORE FAMILIAR WITH
THAT.
ONCE THE STIMULATION HAS RUN, IT
WILL POP OUT A VISUALIZATION OF
THE ELECTRIC FIELD LOOKS LIKE
FOR POST SIMULATIONS, AND IT
WILL TAKE JUST A LITTLE BIT.
NOW SOLVING IT.
AND I THINK THE VISUALIZATIONS
COMING UP NOW.
SO YOU CAN SEE WHAT THE
VISUALIZATION CORTEX LOOKS LIKE
AND WHAT THESE ARE.
AND ONCE IT'S CLOSE WE WILL GO
TO TMS AND DO THE SAME THING AND
THEN ALSO [INDISCERNIBLE].
THESE ARE IN THE DISK SO CAN YOU
LOOK AT IT LATER AND ANALYZE THE
DATA AFTERWARDS.
VISUALIZATION IS COMING NOW.
SO CAN YOU SEE THE ELECTRIC
FIELD ON THIS AND THEN THE TMS
AS WELL, SO YOU SEE WHERE YOU
PUT IT.
ALL RIGHT.
AS IN ROAST AS WELL, CAN YOU DO
OPTIMIZATION, SO HERE DEFINE A
TARGET ON THE CORTEX HERE, AND
THEN YOU CAN TRY TO HIT THAT
TARGET FOLKALLY SO MAXIMIZE THE
TARGET, MINIMIZE THE OTHER SIDE
OF THE TARGET AND YOU CAN USE
DIFFERENT ELEKD RODE LAY OUTS
FOR THIS OPTIMIZATION AND THEN
OPTIMIZE THE INPUT CURRENT FOR
EACH ELECTRODE.
YOU CAN ALSO DO SORT OF TRYING
TO HIT A TARGET MAXIMIZE, SO
MAXIMIZE THE ELECTRIC FIELD OF
THE TARGET.
SO HERE THE TARGETS IS KIENTD OF
THE SAME PLACE BUT NOW HERE WE
TRY TO HIT IT AS HARD FOR INPUT
CURRENTS THAT WE'RE ALLOWED TO
USE SO WE WOULD GET SOME
ELECTRODES DIRECTLY OVER THE
TARGET AND OTHER ELECTRODES ON
THE OTHER SIDE OF THE HEAD JUST
TO DRIVE AS MUCH CURRENT THROUGH
THE TARGET AS POSSIBLE.
YOU CAN ALSO DO NETWORK
OPTIMIZATION SO HERE ON THE
LEFT, I'M SHOWING A MAP DERIVED
FROM FMRI ANALYSIS SO WE HAVE
VALUES CLOSE TO 1 IN RED, WE
TROO TO OPTIMIZE THE FIELD
COMPONENT SO THE COMPONENT
POINTS INTO THE CORTEX SO IT
MATCHES THE MAP AND WHERE WE
HAVE VALUES CLOSE TO 1, WE ARE
TRYING TO OPTIMIZE THE POINTS
OUT OF THE CORTEX.
AND HERE IS THE RESULT OF THE
OPTIMIZATION, SO HERE WE HAVE
RED VALUES AND THIS IS POINTING
IN AND WHERE WE HAVE BLUE IT'S
POINTING OUT SO WE'RE TRYING TO
MATCH THIS NETWORK BASED
MAPPING.
EE ALSO DO [INDISCERNIBLE]
OPTIMIZATION SO HERE DEFINE A
TARGET ON THE CORTEX, MAYBE THE
MOTOR CORTEX FOR EXAMPLE AND
THEN WE CAN SEARCH THROUGH
DIFFERENT CORRELATE LOCATIONS
AND HERE IN DIFFERENT LOCATIONS,
THE COLOR CODES HOW STRONG THE
ELECTRIC FIELD HOW STRONG THE
TARGET IS AND HIS SPIKES SHOW
THE ORIENTATIONS AND YOU CAN SEE
WHERE THE PLACE THE COIL TO SORT
OF MAXIMIZE THE ELECTRIC FIELD
AT THAT CORTICALE LOCATION.
WE'VE ADDED MORE MODELS IN THIS
NEW VERSION, SO WE NOW HAVE 25
NEW CORALS, SO YEAH, DIFFERENT
MANUFACTURES AND DIFFERENT
MODELS AND HERE I'M JUST SHOWING
HOW THE ELECTRIC FIELD ON THE
CORTEX LOOKS LIKE FROM THESE
DIFFERENT COILS.
YEAH, FINALLY YOU CAN DO GROUP
ANALYSIS HERE AROUND THE SAME
TDCS MONTAGE FOR 5 DIFFERENT
HEADS, MAP THE FIELD
MANAGENITUDEOT CENTRAL SURFACE
AND THEN MAP THAT TO THE
AVERAGE, HERE IS THE AVERAGE
FIELD MAGNITUDE OVER THESE 5
SUBJECTS DISPLAYED OVER THE
AVERAGE AND HERE'S STANDARD
DEVIATION AND YOU CAN DO THE
SAME AS YOU DO FOR FMRI
ANALYSIS, PERMMENTATION,
EMPHASIS THERE, OR DO STANDARD
PROOF AFLAL SIS STUFF, OR
BASICALLY INTERESTED.
SO IN SUMMARY WE TRY TO WORK
HARD TO MAKE THIS BETTER, WE
WORKED ON THE SEGMENTATION, WE
WORKED ON MAKING THE EDITS TO
THESE SEGMENTATIONS EASIER FOR
USERS AND MAKE THE MESH NOR
FLEXIBLE AND ALSO ON THE
SAMULATION SIDE, WE TRY TO ROUGH
ATOM VIED TOOLS THAT ARE EASY TO
USE FOR OPTIMIZATION OR THE TDCS
AND TMS AND INCLUDE MODELS AND
HERE, ALWAYS DEVELOPING NEW
FEATURES AS A NEED FOR THOSE AND
I WOULD LIKE TO THANK OF COURSE
THE [INDISCERNIBLE] PI AND ALL
THE OTHER PEOPLE IN OUR CENTER,
WHO PROVIDED A LOT OF HELP AND
ON THE SOFTWARE SIDE OF THIS WHO
HELPED WITH THE
SIGNATURESMENTATION AND
DR. GREVE FROM THE MARTIN OS
CENTER WHO PROVIDED US WITH THEZ
SEGMENTATIONS.
THANK YOU.
>>ANY QUESTIONS, PLEASE GO,A
HEAD.
>>THANK YOU FOR THE NICE
PRESENTATION, YOU SAID AT SOME
POINT YOU DON'T HAVE ANY MORE
MET LAB DEPENDENCY?
>>YEAH, IT'S A STAND ALONE
PACKAGE NOW.
>>SO THIS IS GREAT.
SECOND QUESTION.
WHEN YOU TRY TO OPTIMIZE
CURRENTS BASED ON THE TARGET, DO
YOU HAVE TO SPECIFY, LET'S SAY 1
OR A LIST OF TARGET OR COULD YOU
ALSO SPECIFY A MAP OF THE BRAIN
WHICH COULD BE DERIVED OR BASED
ON FUNCTIONAL MRI.
>>SO WE HAVE THIS SORT OF
NETWORK OPTIMIZATION AS WE
SHOWED WITH THE GRIEWBTED
ORGANIZATION INSIDE A CORTICALE
TARGET.
YOU COULD DEFINE MULTIPLE
TARGETS TO TRY TO HIT THOSE SORT
OF LOCATIONS FOR EXAMPLE.
SO THAT'S POSSIBLE.
>>THANKS.
HELLO, THANKS FOR THE TALK, SO
FIRST QUESTION IS, WHAT KIND OF
MEASURING PACKAGES DID YOU USE
IN YOUR [INDISCERNIBLE]?
>>SEGUL MISSION LAB ARRA
TOATORY SO WE TOOK THE SEGUL
LIBRARY AND USED THEM TO MEASURE
THE TOOLS TOUE KNOW MOVE FROM
SERVICE-BASED MESH TO CANNED
WHAT MESH.
I SHOULD MENTION ALSO ALSO USED
IN THE BACK END, SEGUL.
>>SO NOW YOU DON'T CLOSE THE
OPENING.
>>YEAH, EXACTLY YEAH, WE DO
MORPH LOGICAL OPERATIONS TO
CLEAN OUT THE SEGMENTATION SO
THERE IS NO SORT OF NOISY BITS
THAT END UP IN THE FINAL MESH
BUT THERE'S NO NEED ANYMORE TO
DO THIS ARTIFICIAL SORT OF
CLOSING OF THE CIRCUITS THAT'S
CORRECT.
>>MY FINAL QUESTION IS, SO YOU
MENTIONED TRAINING DATA FOR THE
SEGMENTATION, IS THAT A DEEP
LEARNING APPROACH OR THE
CONVENTIONAL?
>>THIS IS VERY CONVENTIONAL, WE
ARE THINKING ABOUT DEEP LEARNING
AS WELL YOU ABOUT MY EXPERIENCE
IS THAT ALTHOUGH YOU NOW HAVE
AUGMENTATION METHODS TO MAKE IT
WORK ACROSS DIFFERENT SEQUENCES
AND MODALITIES, USERS TRY TO PUT
ALL KINDS OF WEIRD DATA INTO
THESE THINGS SO AT LEAST NOW, I
WOULDN'T MOVE DIRECTLY INTO
LEARNING SO I THINK IT'S
FLEXIBILITY BECAUSE WE CAN NOW
INTERACT WITH THE SEGMENTATION
QUITE NICELY.
BUT IT'S AN IDEA TO HAVE AT
LEAST ACCELERATED SEGMENTATION
WITH DEEP LEARNING AT SOME POINT
IN TIME.
>>OKAY, THANK YOU.
>>THANKS.
>>APPROXIMATE ANY OTHER
QUESTIONS?
I DO HAVE A QUESTION.
YOU SHOW US THAT THERE IS LIKE
THE SIMULATION AND YOU CAN SHOW
HOW IT CHANGED THE FIELD
DEPENDING ON THE DIRECTION OF
THE TMS COIL, COULD YOU SHOW US
OR TELL US?
>>YEAH, IT'S--WELL, NOW THE
OTHER PRESENTATION IS GONE.
>>OKAY,.
>>OKAY.
>>OKAY, SO WE WILL CONTINUE.
THEN.
WE HAVE NOW--THANK YOU.
[ APPLAUSE ]
WE HAVE NOW, ZHI-DE DENG, FROM
THE NATIONAL INSTITUTE OF MENTAL
HEALTH.
HE WILL TALK ABOUT THE MODELING
OF TMS.
>>HELLO.
OKAY, CONTINUING THE GREAT PANEL
AND FIRST I WANT TO THANK ANDY
AND OULA AND AXEL FOR DEVELOPING
THESE EASY TO USE SIMULATION
PACKAGES AND I CERTAINLY USE SIM
NIBS IN MY WORK A LOT BUT I WILL
TALK ABOUT CORNER CASES NOW
WHERE PERHAPS OTHER TOOLS MIGHT
BE USEFUL AS WELL IN MODELING OF
TMS.
BUT FIRST, SOME WORK ON
ULTRASOUND BECAUSE THERE'S A LOT
OF INTEREST IN ULTRASOUND, AND
SO, THIS IS SOME EXPERIMENT I
DID WITH POTATOES, SO FIRST THE
EXPERIMENT IS I CUT UP THE
POTATOES INTO RECTANGULAR BLOCKS
AND THEY WERE THEN STEAMED TO
GET THE INSIDE VERY SOFT.
THEY WERE PUT INTO AN ULTRA
SONIC WATER BATH TO TREAT FOR 40
MINUTES AND THAT THEY WERE FRIED
AND DOUBLE FRYING TECHNIQUES
STANDARD FOR COOKING FRENCH
FRIES.
AND WHAT THE ULTRASOUND DOES TO
THE POTATO IS THAT IT WOULD
CRACK THE SURFACE OF THE POTATO
TO CREATE THESE BLISTERS AND
CRASHES SUCH THAT WHEN FRY THEM
IN THE OIL, THERE'S MORE SURFACE
AREA IN CONTACT WITH THE OIL
MAKING THE FRIES MORE CRISPY.
SO THIS IS THE PICTURE, THE
OUTCOME OF THE EXPERIMENT, ON
THE RIGHT THERE'S A STACK OF THE
ULTRA SONIC TREATED FRIES, AND
THEN ALSO I HAVE SOME CONTROL
FRIELS THAT ARE OVER HERE ON
THE--IT'S A CONTROLLED
EXPERIMENT.
AND INDEED YOU SEE THE CRACKS
AND BLISTERS THAT MAKES THE FRY
SO TASTY.
AND SO THAT'S MY WORK ON
ULTRASOUND, I THOUGHT YOU GUYS
WOULD HAVE ENJOYED THAT, AND
BACK TO MODELING OF TMS, AND
MODELING IN GENERAL.
-OF AND TO BENCHMARK TECHNOLOGY
TO SEE HOW DEEP DIFFERENT COIL
STIMULATE AND SO ON.
THE SECOND REASON FOR RUNNING
COMPUTATIONAL MODELS FOR ME IS
TO QUANTIFY DOSING IN
INDIVIDUALS TO STUDY INTRA
INDIVIDUAL VARIABILITY TO ARK
ASSESSES TARGET ENGAGEMENT
WHETHER YOU HAVE STIMULATED THE
TARGET OR NOT AND THE THIRD
REASON IS TO GUIDE TECHNOLOGY
DEVELOPMENT TO USE THESE
COMPUTATIONAL MODELS TO REFINE
TECHNOLOGY OR WITH THE TMS, COIL
AND SO IN THE ORIGINAL
EXPERIMENT, HE TOOK A PRIMARY
COIL A AND VICINITY WITH A
SECONDARY COIL SPOOL OF WINDING
B AND HE WILL RUN A TIME VARYING
CURRENT IN THE PRIMARY COIL TO
INDUCE AN ELECTRIC CURRENT IN
THE SECONDARY COIL AND DHS
ELECTROMAGNETIC INDUCTION FORMS
THE BASIS FOR TRANSCRANIAL
INDUCTION TODAY.
BUT SOME SOME OF FARADAYS
EXPERIMENTS HE WOULD REPLIES THE
PRIMARY COIL A WITH A PERMANENT
BAR OF MEG NET AND HE WOULD TAKE
THIS PERMANENT MAGNET AND MOVE
IT PHYSICALLY IN AND OUT OF THE
SECONDARY WINDING TO CREATE THIS
CURRENT FLOW.
AND IN FACT, THIS IS--THIS
TECHNIQUE HAS BEEN PROPOSED IN
SEVERAL DIFFERENT SYSTEMS FOR
TREATMENT OF NEUROLOGICAL AND
PSYCHIATRIC CONDITIONS.
THE 1 ON THE LEFT IS USING
MULTIPLE MAGNETS THAT AMOUNTED
ON A CAP AND TREATMENT SYSTEMS
FOR DEPRESSION AND I'LL SHOW YOU
SIMULATIONS OF EACH 1 OF THESE.
FIRST THE TRANSCRANIAL ROTATING
MAGNET STIMULATION, THE 1 THAT
WE'RE SHOWING ON THE CAP ON THE
LEFT, THEY'RE USED AXIALLY
MAGNETIZED CYLINDRICAL VERY
STRONG MAGNETS, THEY ARE QUITE
SMALL, THEY'RE ABOUT THE SIZE OF
YOUR PINKY, QUITE STRONG SURFACE
ELECTRIC FIELD WITH MAGNETIC
FIELD RATHER WITH REMANENT
SURFACE MAGNETIC FIELD UPWARDS
OF 1.4 A TESLA AND THE MAGNET
ARE BEING SPUN, ROTATED
PERPENDICULAR TO THE SCALP AT A
SPEED UPWARDS OF 24,000 RPM.
NOW THIS MAY SEEM LIKE A VERY
FAST ROTATION SPEED BUT IT'S
REVOLUTIONS PER MINUTE SO IT'S
ACTUALLY ONLY ABOUT 400-HERTZ,
COMPARED THAT TO THE FREQUENCY
OF A TMS PULSE WHICH IS ABOUT 5
KILOHERTZ WHICH IS ALREADY AN
ORDER OF MAGNITUDE SLOWER USING
THIS PHYSICALLY ROTATING SYSTEM.
IN TERMS OF THE STIMULATION, THE
PHYSICS OF IT IS THAT THE
CONDUCTING PARTS OF THE ROTOR,
THE PART THAT'S MOVING IS
MODELED USING AMPIERS LAW AND
THE NONCONDUCTIVE PARTS OF THE
ROTOR AND THE STATER, STATER IS
THE PART THAT'S STATIONARY HAD
IS MAGNETICKER POTENTIAL AND YOU
SEE HERE, THE GEOMETRY KRAWN,
THE SOFTWARE USED HERE IS
CONSOLE AND YOU CAN SEE THAT
INSIDE THE CYLINDRICAL MAGNET
BUT THEN YOU ALSO HAVE TO DRAW
AN AIR BOX AROUND IT THAT
ROTATES WITH THE MAGNET.
THE REASON FOR DOING THIS IS
THAT IS ACTUALLY A MOVING MESH
SO IT'S A TIME DEPENDENT SYSTEM,
3D PROBLEM THAT INVOLVES
ROTATION OF THE MAGNET SO THE
WHOLE MESH IS MOVING AND WHEN
YOU HAVE A MOVING MESH, YOU HAVE
TO MAKE SURE THAT EVERY STEP OF
THE ROTATION, THE CUT INTERFACE,
ROTATING INTERFACE MATCH AS YOU
ROTATE.
SO HENS, YOU HAVE TO ROTATE ALSO
SOME AIR AROUND IT.
SO AGAIN, THESE MAGNETS ARE
AXIALLY POLARIZED AND THE AXIS
OF ROTATION IS ALWAYS PARALLEL
TO THE HEAD IN THIS PARTICULAR
SITUATION, THE AXIS OF ROTATION
IS PERPENDICULAR TO THE AXIS OF
MEASUREMENT, YOU SEE THE
SPHEREICAL SURFACE THAT
REPRESENTS THE KD--SALLY THAT'S
CLOSER TO THE MAGNET IS MORE
FINELY MESH BECAUSE YOU WANT TO
GET AN ACCURATE SOLUTION THERE.
SO THIS IS AN ANIMATION OF WHAT
THE ELECTRIC FIELD ON THE
SURFACE OF THE HEAD WOULD LOOK
LIKE AS THE MAGNET IS ROTATING,
SO YOU CAN SEE THAT AS THE
MAGNET IS SPINNING, IT ACTUALLY
CREATES QUITE AN INTERESTING
FIELD PATTERN UNDERNEATH, IT
SWITCHES FROM WHAT LOOKS LIKE A
FIGURE OF 8 COIL TMS COIL TO
SOMETHING THAT IS CIRCULAR.
SO YOU HAVE THAT FIELD PATTERN.
THE OTHER SYSTEM THAT'S--THAT
WE'RE STUDYING HERE IS CALLED TO
SYNCHRONIZED TMS OR STMS, IT WAS
PRACTICES POSED BY
[INDISCERNIBLE] FROM UCLA A
COUPLE YEARS AGO IN WHICH HE WAS
TRYING TO TREAT THE PROBLEM OF
DEPRESSION AND HE WAS LOOKING
FOR A WAY TO TRAIN CORTICALE
OSCILLATORS, AND USING ROTATING
MAGNETIC FIELD AND PROPOSED THAT
BY PLACING MAGNETS ALONG THE
FROBTAL POLAR REGION, ALSO
MIDLINE FRONTAL AND ALSO PART OF
THE PARIETAL REGION, AND TRAIN
THE OSCILLATORS, USING ROTATING
MAGNETS, YOU WOULD RESET SOME OF
THESE CORTICALE THALAMIC
OSCILLATORS AND THAT WOULD
SOMEHOW RELIEVE DEPRESSIVE
SYMPTOMS.
THE BIOLOGY I DON'T KNOW SO
WELL, BUT ANYWAY, SO A SYSTEM
WAS ABOUTLET FOR THIS PURPLES
AND THESE ARE SLIGHTLY DIFFERENT
MAGNETS THAT ARE A LITTLE BIT
BIGGER.
THEY'RE ABOUT 1 INCH IN DIAMETER
WITH A HEIGHT AND A SLIGHTLY
LOWER SURFACE FIELD OF .64
TESLA, AND THEY'RE ROTATED QUITE
SLOWLY.
THE ENTRAINMENT PROCESS HAS TO
DO WITH MATCHING THE SPEED OF
ROTATION OF THE MAGNET, TO
INDIVIDUALIZED ALPHA FREQUENCIES
SO EEG WOULD BE MEASURED FROM
THE OCCIPITAL LOBE IN THE HEAD
AND YOU PICK OUT THE PEAK
ALPHAFREQUENCY FOR THAT
INDIVIDUAL AND THEN YOU WOULD
SET THE ROTATION OF THE MAGNET,
SYNCHRONIZED, HENS THE NAME,
SYNCHRONIZED TMS, SYNCHRONIZE TO
THE OSCILLATION BUT 10-HERTZ IS
ACTUALLY VERY SLOW FOR THIS
PURPOSE.
THIS IS WHAT IT WOULD LOOK LIKE.
OH THESE MAGNETS ARE
DIAMETRICALLY MAGNETIZED AND
THEY ARE ALSO ROTATING PARALLEL
TO THE HEAD AND SO ACTUALLY WHAT
YOU END UP WITH IS A FIELD
PATTERN THAT LOOKS PRETTY MUCH
EXACTLY THE SAME AS THE SMALLER
MAGNET WHEN IT'S SPINNING
PERPENDICULAR.
INTERESTING TO WATCH.
AND THIS IS THE SIMULATION OF
THE HOST SET UP WITH THE 3
MAGNETS, FRONTAL POLE, MIDLINE,
AND PARIETAL REGION AND HAD IS
THE SIMULATION OF THE WHOLE
SYSTEM.
THERE'S A HYPNOTIC EFFECT TO IT.
THERE'S SOMETHING ABOUT THIS
THAT MAKES YOU WANT TO WATCH IT
ALL DAY.
SOMETIMES I DO.
[LAUGHTER]
BUT THE MORE BENCH ANT OF YOU
WOULD NOTICE THE SCALE ON THE
RIGHT, YOU SEE THE ELECTRIC
FIELD INDUCED ON THE SURFACE OF
THE HEAD IS QUITE LOW ON THE
ORDER OF .06 BOLTS PER METER.
SO THIS IS ABOUT AN ORDER OF
MAGNITUDE LOWER COMPARED TO
SOMETHING LIKE TADS, OR TDCS
CONVENTIONAL STRENGTHS.
THIS IS A PICTURE IN CASE MY
ANIMATION FAILS.
SUBSEQUENTLY THERE WAS A PAPER
RETIRED WITHEN ABOUT TRYING TO
PREDICT RESPONSE TO THE
SYNCHRONIZED TMS FORM FOR
TREATMENT OF DEPRESSION AND
AMONG MANY PREDICTERS IT WAS
FOUND THAT LOWER IAF, THAT'S THE
INDIVIDUAL ALPHA FREQUENCY
PREDICTED POORER RESPONSE.
NOW, REMEMBER I SAID THE MAGNET
IS SYNCHRON ICED TO IAF, IT
TURNS OUT THAT THE ELECTRIC
FIELD STRENGTH THAT IS INDUCED
IS PROPORTIONAL TO THE
ROTATIONAL SPEED OF THE MAGNET.
SO IF A SUBJECT HAS LOWER, THIS
ALPHA FREQUENCY, THE MAGNET
WOULD ALSO BE ROTATING SLOWLY,
SLOWER AND SO THE DOZE THAT
ENDED UP ON THE BRAIN IS ALSO
LOWER WHICH CREATES A COMPOUND
FOR SUCH A MOVING MAGNET SYSTEM,
THAT THERE'S NOT A WAY TO
INDEPENDENTLY SEPARATE THE
FREQUENCY EFFECT VERSUS THE
FIELD STRENGTH AND PERHAPS IF WE
WERE TO BUILD THIS SYSTEM AGAIN,
AN ALTERNATIVE WATO BUILD IT
WOULD BE TO REMOVE MAGNETS
RATHER THAN PERMANENT WE
REMOVING MAGNETS USE AG I 3
PHASE MOTOR FOR EXAMPLE, AND YOU
HAVE A SIMPLE VERSION OF THE 3
PHASE MOTOR IN WHICH YOU HAVE 3
PAIRS OF WINDINGS THAT ARE
ALTERNATING IN CURRENT AND WHAT
HAVE YOU AIAN ROTATING MAGNETIC
FIELD VECTOR INSIDE THE MOTOR.
SO THIS SYSTEM AT LEAST WILL
ALLOW YOU TO CONTROL THE
AMPLITUDE VERSUS THE FREQUENCY
SO THAT YOU DON'T HAVE TO
COMPOUND.
SO THIS IS AN EXAMPLE THROUGH
COMPUTATIONAL MODELS HOW IT
WOULD HELP YOU FIND THE NEXT
ITERATION.
NEXT TECHNOLOGY STICKING WITH
THE THEME OF LOW FIELD, THIS WAS
LMS DISCOVERED BY ACCIDENT AT
MCLEAN HOSPITAL UP IN BOSTON.
MICHAEL ROHAN WAS SCANNING
PATIENTS USING A NEW EPI
SEQUENCE THAT LOOKS LIKE THIS
AND THESE PATIENTS CAME OUT UTR
OF SCANNA PREPORTEDLY FEELING
BETTER ABOUT THEIR SYMPTOMS SO
DR. ROHAN SAID THERE MUST BE
THAT SOMEHOW STIMULATED THE
WEEKLY, THE PATIENTS WITH
SYMPTOM RELIEVE AND SO A COMPANY
WAS FORM PFED AROUND LMS
TECHNOLOGYNOLOGY TO TRY TO USE
THIS COUNTER TOP COIL TO TREAT
DEPRESSION AND THIS IS THE WAY
WAVE FORNL FOR THE FIELD AND
LOOKED LIKE ECT PULSES BUT
FASTER BUT ALSO AT A VERY LOW
STRENGTH BECAUSE THE CURRENT IS
VERY LOW.
THESE ARE THE KRINICAL RESULTS
DONE IN CORNELL, THEY ARE
COLLECTED AT CORNELL AND YOU CAN
SEE THAT IN THIS VISUAL AN LOG
SCALE OF MOOD RATINGS THAT AS
SHORT AS COUPLE OF SESSIONS
BETWEEN ACTIVE AND SHAM GROUPS
SO THERE'S SOME PROMISE THERE.
THE COIL ITSELF IS VERY BIG,
IT'S AN MRI GRADIENT COIL AND IT
STIMULATES A LOT OF BRAIN
REGIONS IN A VERY WEEK ELECTRIC
FIELD MOST STRONGLY THE FRONTAL
POLAR REGION, THE LINED FRONTAL
REGIONS ARE BROADLY STIMULATED
USING THIS COIL.
COIL CURRENT IS QUITE LOW, NOT
MORE THAN 30-AMPS OR SO BUT THE
COIL IS SO BIG AND SO FAR AWAY
THATS NOT VERY EFFICIENT AND SO,
THE COMPANY CONTRACTED OUR TEAM
TO ACTUALLY REDESIGN THIS COIL
TO MAKE SOMETHING MORE ENERGY
EFFICIENT AND MORE PORTABLE, AND
THE WAY WE DID IT IS--FIRST, WE
USE A SPHEREICAL HARMONICS
COMPOSITION OF THE ELECTRIC
FIELD AND SO BASICALLY THE IDEA
IS IT'S KIND OF LIKE A
DECOMPOSITION, RIGHT?
SO YOU HAVE A SET OF BASIS
FUNCTIONS WHICH YOU ADD UP TO
FORM AN ARBITRARY WAVE FORM.
IN 3 DIMENSIONS IN ON THE
SURFACE FEAR, YOU HAVE THESE
HARMONICS SO CROSS SPHEREICAL
HARMONICS WITH DIFFERENT SPATIAL
REFREQUENCIES AND WHEN YOU SUM
UP A NUMBER OF OF THESE BASIS
FUNCTIONS YOU CAN ARRIVE IN AN
ARBITRARY ELECTRIC FIELD.
AND SO THAT'S THE CONCEPT AND SO
YOU WOULD HAVE THIS SPHEREICAL
HARMONICS EXPANSION AND THEN
HAVE YOU AN ELECTRIC FIELD THAT
YOU WANT TO ACHIEVE BECAUSE WE
HAVE SIMULATED WHAT THE ACTUAL
LFMS COIL IS AND SO YOU WOULD
BASICALLY RUN A MINIMIZATION
PROBLEM, MINIMIZING THE
DIFFERENCE DESIRABLE ELECTRIC
FIELD, THE ELFMS, AND ALSO THE
SPHEREICAL HARMONIC
DECOMPOSITION FORNL OF THE
ELECTRIC FIELD.
WITH THIS MINIMIZATION FRAMEWORK
YOU CAN ALSO TAKE INTO ACCOUNT
SOME CONSTRAINTS SUCH AS ENERGY
CONSTRAINTS WHICH YOU MED LIKE
TO MEN MYSELF OR ALSO PLACEMENTS
OF THESE STREAM FUNCTIONS, SO
FOR EXAMPLE, YOU DON'T WANT TO
END UP WITH COIL WINDINGS THAT
ARE BELOW THE TOP HEMISPHERE
LIKE CUTTING INTO THE NECK FOR
EXAMPLE, THAT WOULD BE UNSAFE.
AND YOU CAN ALSO LIMIT TD NUMBER
OF TERMS IN YOUR SPHEREICAL
HARMONICS EXPANSION FOR THIS
APPROXIMATION.
SO THE RESULT IN COIL, I LOST
THE NEXT SLIDE, BUT OKAY, THE
RESULTING COIL IS WHAT YOU SEE
ON THE LOWER LEFT WHICH IS MORE
COMPACT COIL THAT WOULD PRO DUCE
A SIMILAR ELECTRIC FIELD
COMPARED TO THE LFMS COIL.
THE NEXT SLIDE WAS SUPPOSED TO
SHOW THAT DIFFERENCE BUT SOMEHOW
THAT'S NOT SHOWING UP.
NEITHER IS THIS 1.
WHICH I WAS GOING TO TALK ABOUT
LOW FIELD MAGNETIC STIMULATION
IN THE RODENT MODEL BECAUSE
RODENTS HAVE SMALLER BRAINS SO
IT'S DIFFICULT TO GENERATE A
HIGH ELECTRIC FIELD IN THEIR
BRAIN AND SO WHAT YOU END UP
DOING WITH ANY COIL DESIGN IS IN
EFFECT LOW FIELD STIMULATION.
OH THIS IS NOT GOOD.
THIS IS NOT GOOD.
YOU HAVE TO USE YOUR IMAGINE
WHILE EYE DESCRIBE WHAT'S
HAPPENING HERE.
SO THIS IS AN EXPERIMENT THAT
WAS DONE IN RODENTS USING A
MINIATURE TMS COIL TO STIMULATE
THEIR CEREBELLUM.
THIS IS AN EXPERIMENT IN
COLLABORATION WITH THE LAB IN
FRANCE WITH RACHEL'S LAB AND
IT'S A CLEVER EXPERIMENT IN
WHICH THEY WENT INTO THE MOUSE
AND PERFORMED SURGERY ON THEM TO
REMOVE THE WHITE MATTER
CONNECTION BETWEEN THE INFERIOR
[INDISCERNIBLE] AND CONNECTING
TO THE CEREBELLUM, BUT ONLY
UNILATERAL.
SO ONLY ON 1 SIDE, THE RIGHT
SIDE IS INTACT FOR THE CONTROL
AND THEN THEY WOULD APPLY THIS
LOW FIELD STIMULATION IN THE
MOUSE FOR 2 WEEKS AND WHAT YOU
WOULD SEE ON THE SCREEN IS THAT
AFTER 2 WEEKS OF ACTIVE
STIMULATION, AT THE WHITE MATTER
FIBER ATTRACTS THE AXON STARTS
TO GROW BACK CONNECTING THE
INFERIOR [INDISCERNIBLE] TO THE
EXPERIMENT, SO SOMEHOW AT EVEN
AT VERY LOW MAGNETIC FIELD AND
ELECTRIC FIELD STRENGTHS, IT'S
HAVING THIS NERVE REGENERATION
PROPERTY: THIS IS--THIS SLIDE
SURVIVED.
THIS IS AN INVITRO EXPERIMENT,
PART OF USING A BRAIN SLICE, SO
HAVE YOU THE INFERIOR OLIVE OVER
HERE, THE CEREBELLUM WHICH IS
NORMAL INNERIVATING AND THEN
WHAT YOU DO IS YOU WOULD GRAPH
ON TO THIS PIECE OF TISSUE,
ANOTHER PIECE OF CEREBELLUM ON
TOP OF THE CEREBELLUM AND USING
STIMULATION, EXTERNALLY, YOU
WOULD TRY TO PROMOTE THE GROWTH
OF THE AXON FROM THE INTACT
PIECE TO THE GRAFTED PIECE OF
CEREBELLUM.
AND FROM THE SIMULATIONS OF THIS
WORK, THE ELECTRIC FIELD THAT IS
ACHIEVED ON THE SLICE IS ON THE
ORDER OF 5-VOLTS PERMETER SO
VERY, VERY LOW ELECTRIC AND
MAGNETIC FIELD AND ACTUALLY WHAT
WE FOUND FROM THE IMMUNO
IMMUNOHISTOCHEMISTRY AND THAT
THE NUMBER OF CPH OS CELLS THAT
WERE IMAGED DOUBLED USING THIS
BIOMETRIC HIGH FREQUENCY
STIMULATION.
NOW THIS BIOMETRIC HIGH
FREQUENCY STIMULATION USES
NEUROWN ACTIVITY SO IT'S A POST
SEQUENCE THAT IS A MIXTURE OF
HIGH AND LOW FREQUENCY
STIMULATION.
AND IT SEEMS TO BE WORKING
BETTER COMPARED TO SOME OTHER
PROTOCOLS THAT ARE FIXED
REQUENCY EVEN BURT PROTOCOLS
LIKE TBS, SO THIS IS SHOWING
THERE'S SOME LEVEL OF ACTIVATION
WITH HIGH FREQUENCY STIMULATION.
THIS IS AN INTERESTING
EXPERIMENT, IT WAS A KNOCK OUT
EXPERIMENT, IN WHICH THEY
KNOCKED OUT THE QUICK 1 AND 2
GENES.
IN MICE, YOU CAN SEE THAT THE
WILD-TYPE, RECEIVING SHAM
STIMULATION, VERY LOW LEVEL OF
CELLULAR ACTIVATION.
SO THIS IS AN IMAGE OF THE
GLUTAMATE TRANSPORTER SO YOU SEE
THAT IN SHAM SIMULATION, IT'S
VERY LOW LEVEL, SO NOTHING
HAPPENS IN THE WILD-TYPE
RECEIVING SHAM.
WILD-TYPE MOUSE GETTING THIS
BIOPNEUMATIC HIGH FREQUENCY
STIMULATION.
YOU START TO SEE THE CULTURE
GROWING AGAIN.
SO YOU HAVE THIS REINNERVATION
BETWEEN THE OLIVE AND THE MOUSE.
BUT THEN IN THE KNOCK OUT MOUSE
IT COMPLETELY ABOLISHED IN THE
DOUBLE STIMULATION, SO THE
DOUBLE KNOCK OUT IN THE THIRD
BAR THERE APPLYING HIGH
FREQUENCY STIMULATION AND IN A
MOUSE THAT DOES NONAPOPTOTIC THE
HAVE THIS QUICK 12 GENE,
COMPLETELY ABOLISHED THE
RESPONSE TO MAGNETIC
STIMULATION.
BUT IS IT BECAUSE YOU HAVE
KNOCKED OUT THE AXON
REGENERATION MACHINERY.
NO.
BECAUSE WHEN YOU APPLY BDNF TO
THAT KNOCK OUT, SAMPLE, THE
AXONS START TO GROW BACK AGAIN.
SO THE GENE SEEMS TO BE A
SPECIFIC MAGNETIC RESPONSE AND
IN CERTAIN SPECIES, THE GENE WAS
THOUGHT TO CODE FOR MAGNETO
RECEPTION SO THAT'S VERY
INTERESTING.
IN HUMAN THE CRY 12 GENES
LICENSE ACTIVITY SO WE STILL
QUESTION WHAT THE TRANSLATION IS
BETWEEN THE MOUSE AND THE HUMAN
MODEL.
BUT VERY INTERESTING EXPERIMENT
THAT WE FOUND THIS SORT OF
MAGNETO RECEPTION EFFECT.
OKAY, SO A LOT OF THESE MOUSE
EXPERIMENTS ARE USING VERY BASIC
SOLENOID COILS AND THIS IS VERY
OTHER PROPOSALS TO MANUFACTURE
THESE MICROTMS COILS FOR ULTRA
FOCAL BRAIN STIMULATION AND
THESE MIKE RODES ARE--THESE
COILS ARE MICROFABRICATED.
THEY'RE VERY SMALL AND SOME
PROPOSE TO DO TRANSCRANIAL
STIMULATION WITH THEM AND
THERE'S THE STRUCTURE IS
BASICALLY JUST A SOLENOID AND
THEY WOULD COMPENSATE WITH THE
FACT THAT THE COILS ARE VERY
SMALL, BY ADDING NUMBER OF TURNS
TO THE COIL.
SO THESE COILS OFTEN WOULD END
UP WITH HUNDREDS OF TURNS, SO
THEY WOULD TELL ME, THE SFR
CERTAINLY--CERTAINLY QUAIGZ
WOULD PREDICT AS YOU INCREASE
THE NUMBER OF TURNS IN YOUR
COIL, YOU WOULD ALSO INCREASE
THE MAGNETIC FIELD THAT IS
INDUCED IN THE SOLENOID.
CORRECT.
BUT WHEN YOU PACK THE FEBRUARY
OF TURNS AND MAKE THE COIL VERY,
VERY TALL, YOU SEE THAT THIS
EQUATION AND INVERTLY PROPORTION
AT TO THE HEIGHT OF THE COIL, SO
WHEN YOU BUILD A VERY LONG AND
TALL COIL, IT'S ACTUALLY
DECREASING IT HAS A
COUNTERACKING.
IT IS ELECTRIC FIELD IS
INVERSELY PROPORTIONAL TO THE
NUMBER OF TURNS IN THE COIL.
SO BY INCREASING THE NUMBER OF
TURNS, YOU HAD ACTUALLY REDUCED
THE ELECTRIC FIELD RATHER THAN
ACHIEVING A HIGHER FIELD OF
STRENGTH.
SO THE LESSON HERE IS THAT 1
DOES NOT SIMPLY INCREASE THE
NUMBER OF TURNS.
NOT WITHOUT DOING MORE STUFF TO
YOUR COIL, RIGHT?
SO THE COIL FOR EXAMPLE, THAT
THEY PRESENTED YESTERDAY HAS
MORE TURNS AND IT'S A VERY TALL
COIL BUT INSIDE THIS IS A FLUX
HIGHWAY, AND WE'RE NOW WRITING
SOFTWARE TO SIMULATE THESE COILS
WITH MAGNETIC MATERIAL TO SEE
HOW WELL THESE NONLITIGATING
MATERIAL CAN HELP WITH IMPROVING
THE EFFICIENCY OF TMS COILS AND
SO ON.
SO THIS IS IN COLLABORATION WITH
[INDISCERNIBLE] AT MPh, AND
WE'RE WRITING SOFTWARE THAT
WOULD ALLOW TO YOU DRAW AND COIL
GEOMETRY IN BOTH ANIMAL MODELS
AND HUMAN MODELS SO SUCH THAT
YOU CAN START TO LOOK AT AND THE
CONTRIBUTION OF THIS NONLINEAR
MATERIAL.
[LAUGHTER]
SO SOMEHOW MY SLIDES ARE NOT
SHOWING UP BUT IN THE INTEREST
OF TIME WHY DON'T I JUST SKIP
ALL THE WAY TO THE END COLLECT
200 THERE IS AND GO TO MY
CONCLUSIONS SLIDE FOR THE
INTEREST OF TIME.
SO IN THIS TALK, I HOPE THAT
I'VE SHOWN YOU SOME EXAMPLES OF
HOW COMPUTATIONAL MODELS CAN BE
USEFUL IN A VARIETY OF WAYS
INCLUDING STUDYING DOSING,
STUDYING THE PHYSICS OF THE
STIMULATION, AND HOW TO USE
THESE COMPUTATIONAL MODELS TO
DEVELOP NEW TECHNOLOGY AND I'VE
SHOWN YOU EXAMPLES WITH MAGNETIC
STIMULATION IN DIFFERENT SPECIES
OF ANIMAL AND ALSO VERY
DIFFERENT RANGE OF ELECTRIC
FIELD STRENGTHS AND SO
HOPEFULLY, YOU HAVE AN
APPRECIATION OF THE POWER OF
THESE COMPUTATIONAL MODELS AND
WITH THAT, YOU GUYS HAVE BEEN
WONDERFUL AUDIENCE THAT STAYED
WITH ME.
THANK YOU.
[ APPLAUSE ]
>>THANK YOU, I HAVE QUESTIONS.
>>CAN YOU GO CLOSER TO THE
MICROPHONE.
>>PUSH IT DOWN.
>>THANK YOU.
SO THANK YOU FOR PRESENTATION.
I HAVE A QUESTION ABOUT YOUR
REAL MODEL IN [INDISCERNIBLE].
SO DO YOU HAVE REAL LIKE BRAIN
MODEL OR IS IT JUST A SCHEME?
, YEAH, SO TALKING ABOUT THE
ROTATING MAGNETS BECAUSE I KNOW
IT'S DIFFICULT TO IMPORT REAL
MODELING [INDISCERNIBLE] AND IF
YOU WANT TO GO WITH GRAY MATTER,
WHITE MATTER, SO MANY LAYERS
MESHING SO I HAVE A QUESTION
ABOUT THAT.
>>WE HAVEN'T DONE THAT.
WE HAVE IMPORTED A UNIFORM MODEL
THAT HAS A HEAD SHAPE TO IT.
THAT'S AS FAR AS WE'VE GONE AND
BECAUSE IT WASN'T THE GOAL TO
REALLY SIMULATE THIS TECHNOLOGY
ON INDIVIDUAL BRAINS IT WAS MORE
OF AN EXPLORATION OF WHAT IS
EVEN THE ORDER OF MAGNITUDE OF
THIS SYSTEM SO THE--WE HAVEN'T
GONE TO THE LENGTH OF IMPORTING
A MULTISHELL MODEL YET.
THAT IS A CHALLENGE.
I STARTED EXPLORING THAT FOR
EXAMPLE, ALREADY INCORPORATING
THE MESH OF THE MAGNET, ALREADY
IN THE SEGMENTATION, THAT
DOESN'T TURN OUT BECAUSE YOU
NEED A MESH TO BE MOVING, SO
THATIA DIFFICULT THING TO DO.
IT'S A VERY CHALLENGING PROBLEM,
I DON'T KNOW OF ANY GOOD WAY OF
DOING IT IN CONSULT, FOR ANY
SOFTWARE.
>>OKAY, SO IT'S JUST THE SCHEME
AND IT'S LIKE MRI?
>>YEAH, IT'S UNIFORMLY
CONDUCTING HEAD MODEL, UNFORM
CONNECTIVITY WHICH MAY BE OKAY
FOR MEG NATTIC STIMULATION.
>>YEAH, OKAY.
OKAY, THANK YOU.
>>THANK YOU.
YES, SIR.
YES, SIR, TALK LOUDER.
>>OKAY, [INAUDIBLE QUESTION
FROM AUDIENCE ]
>>IT REMAINED CRISPY FOR MUCH
LONGER IT'S ACTUALLY A GREAT
EXPERIENCE.
IT'S ACTUALLY ALREADY A PATENTED
TECHNIQUE.
IT WAS PATENTED BY A GAME NAMED
NATHAN MERFEL WHO WAS THE FORMER
CTO OF MICROSOFT.
>>DO WE HAVE ANYMORE QUESTIONS?
I THINK WE WILL SAY THANK YOU
ZHI FOR YOUR PRESENTATION.
[ APPLAUSE ]
>>SO THE NEXT SPEAKER WILL BE
THE NEXT PRESENTATION WILL BE
DELIVERING A RECORDING, IT'S
FRANK FROM USC STEPHEN'S
NEUROIMAGING AND INFORMATICS
INSTITUTE FROM THE KKS ECK
SCHOOL OF MEDICINE, UNIVERSITY
OF SORGTERN CALIFORNIA, IF YOU
COULD START THE PRESENTATION,
PLEASE?
>>HELLO, EVERYONE MY
PRESENTATION IS FOCUSED ON THE
IMPORTANT TOPIC OF THE MRI
RELATED SAFETY ISSUES FOR
NEUROMODDULATION SYSTEMS.
NEUROMODULATION UTILIZEs A
MEDICAL DEVICE TO RELIEVE
SYMPTOMS THROUGH ALTERATION OR
MODULATION OF NERVOUS SYSTEM
FUNCTION VIA THE TARGETED
DELIVERY OF A STIMULUS SUCH AS
ELECTRICAL STIMULATION OR A
CHEMICAL AGENT TO A SPECIFIC
NEUROLOGICAL SITE IN THE BODY.
NEUROMODULATION THERAPIES HAVE
BEEN AVAILABLE SINCE THE 1960S
AND ARE AN ESSENTIAL TOOL FOR
HEALTHCARE PROFESSIONALS.
THE FIELD OF NEUROMODDULATION
ENCOMPASSES A WIDE RAIRVELG OF
THERAPEUTIC APPLICATIONS FROM
CHRONIC PAIN TO NUROLOGICAL
CONDITIONS SUCH AS EPILEPSY,
DYSTONIA AND PARKINSON'S DISEASE
WITH THE GOAL OF SUPPORTING THE
RECOVERY OF ABILITIES SUCH AS
HEARING, VISUAL AND MOBILITY, AS
WELL AS THE CONTROL OF PLATTER
AND BOWEL FUNCTION.
TECHNOLOGICAL ADVANCES IN
NEUROSCIENCE COMBINED WITH
NEURAL MODULATION SYSTEMS THAT
WERE MIN RATTURIZED TO FEASIBLY
PRESENT INFORMATION CONTRIBUTED
TO THE EXPONENTIAL GROWTH OF
NEUROMODDULATION APPLICATIONS
INCLUDING THOSE USED FOR DEEP
BRAIN STIMULATION, PERIPHERAL
NERVE STIMULATION, SPINAL CORD
STIMULATION, SAN FRANCISCO KRAL
NERVE STIMULATION, VAGUS NERVE
STIMULATION AS WELL AS
ADMINISTRATION OF DRUGS FOR PAIN
MANAGEMENT.
NOTABLY NEURAL MODULATION
SYSTEMS ARE THE FASTEST GROWING
SEGMENT OF THE THE MEDICAL
DEVICE INDUSTRY.
THE PRESENTATION OF A SAFE MRI
ENVIRONMENT REQUIRES HEALTHCARE
PROFESSIONALS TO BE PARTICULARLY
ATTENTIVE TO THE MANAGEMENT OF
PATIENT WHORS HAVE METAL
IMPLANTS FOR THIS PART THE
PROCEDURE INVOLVES IDENTIFYING
THE PRESENCE OF THESE DEVICES
AND THAT INCLUDING ACTIVE
IMPLANTS SUCH AS NEURAL
MODULATION SYSTEMS.
VORCE MRI RELATED ISSUES CAN
IMPACT NEURAL MODULATION SYSTEMS
AND THAT INCLUDES THOSE
ASSOCIATED WITH MAGNETIC FIELD
INTERACTIONS NAMELY FORCE AND
TORQUE ACTING ON IMPLANTABLE
PULSE GENERATORS OR LEADS AND
ELECTRODES.
MRI RELATED RF OR GRADIENT
INDUCED HEATING CAN GENERATE
SUBSTANTIAL TEMPERATURE
ELEVATIONS RESULTING IN PATIENT
BURN INJURIES.
IN DUCE CURRENTS THAT CAUSE
UNINTENDED FER DELETERIOUS
STIMULATION MAY ALSO OCCUR.
AND GREATIEND INDUCED VIBRATION
OF THEP IMPLANTED COMPONENTS
MAINLY THE PULSE GENERATORS MAY
RESULT IN TISSUE DAMAGE.
THE ELECTROMAGNETIC FIELDS
UTILIZED DURING MRI CAN
POTENTIAL CHANGE THE OPERATIONAL
ASPECTS OF A NEURAL MODULATION
SYSTEM CAUSING THE FUNCTION TO
BE ALTERED TEMPORARILY AND
PERMANENTLY.
FINALLY ARTIFACTS SOSHTED WITH
THE PRESENCE OF A
NEUROMODDULATION SYSTEM MAY
COMPROMISE THE DIAGNOSTIC USE OF
MRI.
IN CONSIDERATION OF THE VARIOUS
FACTORS THAT CAN POTENTIALLY
IMPACT A NEURAL MODULATION
SYSTEM, SPECIALIZED TEST
PROCEDURES HAD BEEN DEVELOPED
TO,A ASSESSES THE VARIOUS
AFOREMENTIONED MRI RELATED
SAFETY ISSUES FOR THESE ACTIVE
IMPLANTS WHICH ARE DESCRIBED IN
THE ISO TECHNICAL SPECIFICATION
10974.
AS SUCH THERE ARE A TEST TO
CHARACTER MAGNETIC RELATED FORCE
AND TORQUE RF AND GRADIENT
INDUCED HEATING AND GRADIENT
INDUCED VIBRATION, EXTRENSIC
POTENT WRAL THAT RESULT INDEED
UNINTENDED STIMULATION AND TO
ASSESS THE COMBINED EFFECTS OF
THE STATIC, GRADIENT AND RF
FIELDS, WITH RESPECT TO POSSIBLY
CAUSING DEVICE MALFUNCTION OR
DAMAGE.
THE INSTRUCTIONS FOR USE IN THE
PRODUCT MANUEL FOR THE
NEUROMODDULATION SYSTEM MUST
ALWAYS BE CAREFULLY FOLLOWED
WITHOUT DEVIATIONS.
FOR EXAMPLE, YOU MAY NEED TO
FOLLOW INSTRUCTIONS WITH REGARD
TO THE ACCEPTABLE STATIC
MAGNETIC FIELD STRENGTH, THE
TYPE OF TRANSMITTER RF COIL THAT
MUST BE USED, THE SPECIFIC
OBLIGATIONS SORPTION RATE HA
MUST NOT BE EXCEEDED DURING THE
EXAM OR IN SOME CASES A B1 PLUS
GROUP MEANS SQUARE OR BMS VALUE
AS SPECIFIED.
THERE MAY BE TIME ISSUE FOR
GRADIENT FIELDS THAT IS
ACCEPTABLE AND THERE MAY BE
OTHER CONDITIONS TO FOLLOW AS
WELL.
IN ARK DITION, A PARTICULAR
IMPLANTATION CONFIGURURATION OR
PLACEMENT SCENARIO AS WELL AS
SPECIAL PROGRAMMING INSTRUCTIONS
FOR THE DEVICE MIGHT BE
REQUIRED.
AS YOU CAN SEE, THERE ARE MANY
FACTORS TO CONSIDER WHEN
SCANNING PATIENTS WITH
NEUROMODDULATION SYSTEMS AND MRI
TECHNOLOGISTS, RAIDIOGRAPHERS,
AND RAYINGIOLOGYISTS FACE CHAL
ERVELGS WHEN MEETING
REQUIREMENTS FOR THE MRI
PARAMETERS.
TO HELP WITH THESE CHALLENGES,
THE INSTRUCTIONS FOR USE FOR A
NEURAL MODULATION SYSTEM
TYPICALLY PROVIDES A TECH LIST
OR A PATIENT ELIGE INLT FORM
THAT SHOULD ALSO BE USED TO
VERIFY AND DOCUMENT THAT ALL
CONDITIONS ARE CAREFULLY
FOLLOWED FOR THE DEVICE IN ORDER
TO INSURE PATIENT SAFETY
RELATIVE TO THE USE OF MRI.
IT'S FORTUNATE NOTE THAT THE
LABELING FOR CERTAIN NEURAL
MODULATION SYSTEMS MAY HAVE
SPECIFIC SAER OR B1 + RMS
RESTRICTIONS FOR A PARTICULAR
LANDMARKING POSITION OR ANATOMIC
ZONE OF THE PATIENT.
THEREFORE, IT IS IMPORTANT TO
BECOME FAMILIAR WITH THE MRI
RELATED INFORMATION FOR SOME OF
THE MORE COMMON AS WELL AS NOT
SO COMMON NEUROMODDULATION
SYSTEMS IN ORDER TO BE BEST
PREPARE WHD A PATIENT RESEBTS TO
YOUR FACILITY WITH 1 OF THESE
DEVICES.
THE DEVICES USED FOR NEURAL
MODULATION TEND TO HAVE 2
DIFFERENT PLATFORMS ISSUES THE
FIRST 1 INVOLVINGS AN
IMPLANTABLE PULSE GENERATOR OR
IPG, IMPLANTABLE LEAD EXTENSIONS
OR LEADS WITH 1 OR MORE
ELECTRODES LOCATED AT THE ENDS
OF THE LEADS.
THE SECOND CONFIGURURATION
THAT'S USED FOR NEURAL
MODULATION SYSTEMS IS THAT WHICH
INVOLVES AN EXTERNAL POWER AND
STIMULATION SOURCE ALONG WITH
IMPLANTED LEADS AND ELECTRODES.
NOTE THAT THE LEAD ELECTRODE
COMPONENT USED FOR THIS
PARTICULAR CONFIGURURATION IS
RELATIVELY SHORT COMPARED TO
WHAT IS USED FOR THE PREVIOUSLY
DESCRIBED TYPE OF NEURAL
MODULATION SYSTEMS.
IN THIS INSTANCE THE PREDOMINANT
MRI RELATED ISSUES INCLUDE
MOVEMENT OR DISLAGEMENT OF THE
IMPLANTED LEAD ELECTRODE,
HEATING OF THE IMPLANTED WELLED
AND ELECTRODE AND UNINTENTIONAL
STIMULATION OF THE DEVICE.
AN EXTREMELY AND IMPORTANT THING
TO NOTE ABOUT THIS
CONFIGURURATION USED FOR
NEUROMODDULATION DEVICE SYSTEM
THAT THE EXTERNAL COMPONENTS
MUST BE REMOVED FROM THE
PATIENTS PRIOR TO MRI.
NOW I WILL PRESENT SELECTED MRI
LABELING FOR VARIOUS MODULATION
SYSTEMS TO ILLUSTRATE THE
COMPLEXITY OF INFORMATION THAT
MUST BE FOLLOWED TO INSURE
PATIENT SAFETY RELATIVE TO THE
USE OF MRI TECHNOLOGY.
HERE'S AN EXAMPLE OF 1 OF THE
MORE ELABORATE NEUROSTIMMULATION
SYSTEMS THAT EXIST.
THIS IMPLANT IS USED FOR DEEP
BRAIN STIMULATION OR DBS.
THE COMPONENTS INCLOOD A SINGLE
IMPLANTABLE PULSE GENERATOR OR
BILATERAL I PGs, LEAD
EXTENSIONS, LEADS AND
ELECTRODES.
THE ELEBD RODES ARE PLACED IN
DEEP PRAIN POSITIONS, THIS DEEP
BRAIN STIMULATION DEVICE HAS
BEEN ASSESSED USING
COMPREHENSIVE TESTING
TECHNIQUES, TO EVALUATE MAGNETIC
FIELD INTERACTIONS, HEATING
INDUCED CURRENTS, ARTIFACTS AND
PROGRAMMING ALTERATIONS AND
OTHER POSSIBLE MRI SAFETY
ISSUES.
IN 2002, THE NEUROSURGEON ALI
[INDISCERNIBLE] AND OUR PULTY
DISCIPLINARY GROUP BASED AT THE
LEAVE CLAPPED CLINIC CONDUCKED
NUMEROUS INVESTIGATIONS
CHARACTER IETIONZING DEEP BRAIN
STIMULATION SYSTEMS.
THIS RESEARCH, CONTRIBUTED TO
THE FIRST SUCCESSFUL MR LABELING
FOR ACTIVE IMPLANT.
THE DBS SYSTEM FROM MED TRONNIC
WHICH OCCURRED NEARLY 2 DECADES
AGO.
UNFORTUNATELY, 2 SERIES INJURIES
HAVE OCCURRED IN PATIENTS WITH
DBS, WITH MRIs, THESE PATIENTS
UNDERWENT MRI PROCEDURES UNDER
CONDITIONS THAT DID NOT FOLLOW
THE MRI LABELING.
HERE'S A TRANSAXIEL MRI OBTAINED
IN THE PATIENTS WHICH SHOWS THE
DAMAGE IN RELATION TO THE DEEP
BRAIN STIMULATION ELECTRODE.
THIS SUBSTANTIAL INJURY RESULTED
IN A PERMANENT NEUROLOGICAL
DEFICIT IN THE PATIENT.
IN BOTH CASES, THE PATIENTS WERE
SCANNED AT 1 TESLA, 42 MEGAHERTZ
AND OTHER DEVIATIONS FROM THE
GUIDELINES EMPHASIZING THE
IMPORTANCE OF CAREFULLY
FOLLOWING EVERY ASPECT OF THE MR
CONDITIONAL LABELING WHEN
SCANNING PATIENTS WITH ACTIVE
DEVICES.
MED TRONNIC PRESENTLY HAS
SEVERAL DIFFERENT DEEP BRAIN
STIMULATION SYSTEMS THAT ARE
LABELED MR CONDITIONAL INCLUDING
THE FIRST 1 THAT IS APPROVED AT
BOTH 1.5 AND 3 TESLA, WHICH IS
THE PERCEPT PC NEUROSTIMMULATOR
MODEL B35 WO00.
THIS DEVICE HAS FULL BODY
ELIGIBILITY LABELING THAT
INCLUDES LABELING FOR A LEAD
ONLY SYSTEM WHICH IS A FULLY
IMPLANTED LEAD THAT IS
INTERNALIZED AND HAS NO OTHER
IMPLANTED CONNEBTED COMPONENTS
OTHER THAN THE LEAD CAP AND
BURHOLE COVER TO MAINTAIN THE
LEAD POSITION.
SIMILAR TO OTHER ACTIVE
IMPLANTS, THE PRECEPT,
NEUROSTIMMULATOR DBS SYSTEM HAS
A PATIENT CHECK LIST OR
ELIGIBILITY FORM SO THAT MRI
PROFESSIONALS CAN DOCUMENT THAT
ALL CRITICAL INFORMATION IS
ADHERED TO IN ORDER TO INSURE A
PATIENT'S SAFETY.
THE DEEP BRAIN STIMULATION
SYSTEM FROM ABBOT ST. JUDE
MEDICAL HAS MRI RELATED LABELING
INFORMATION FOR LEAD ONLY AND
FULL SYSTEM VERSIONS OF THEIR
DEVICE.
THE CONDITIONS APPLY TO THE USE
OF A 1.5 TESLA SCANNER OHM AND
REQUIRE HIGHLY SPECIFIC TYPES OF
LEADS, AND PULSE GENERATORS TO
BE PRESENT IN THE PATIENT IN
ORDER TO INSURE SAFETY.
THE NEXT MR CONDITIONAL DEEP
BRAIN STIMULATION SYSTEM IS FROM
BOSTON SCIENTIFIC AND IT ALSO
HAS LABELING INFORMATION FOR
LEAD ONLY AND FULL SYSTEM
VERSIONS OF THE DEVICE.
SIMILAR TO THE INFORMATION FOR
THE PRIOR DBS SYSTEM, THE
CONDITIONS APPLY TO THE USE OF A
1.5 TESLA MR SYSTEM ONLY AND
ALSO REQUIRE SPECIFIC LEADS AND
POST GENERATORS TO INSURE THE
SAFE USE OF MREFRESH YOUR
RECOLLECTION I IN THE PATIENT.
THE LABELING DOCUMENTATION WITH
THIS NEURAL MODULATION SYSTEM
ALSO HAS A CHECK LIST THAT CAN
BE USED TO ESTABLISH THE
PATIENT'S ELIGIBILITY FOR AN MRI
EXAM.
THIS IS AN EXTREMELY UNIQUE TYPE
OF NEURAL MODULATION SYSTEM,
IT'S CALLED A RESPONSIVE
NEUROSTIMMULATION SYSTEMS OR RNS
CONSISTS OF A SMALL
NEUROMODDULATION DEVICE THAT IS
IMPLANTED IN THE SKULL THAT
DELIVERS STIMULATION TO BRAIN
SITES AND IS ACTIVATED WHEN
SENSING LEADS DETECT BRAIN
ACTIVITY THAT IS PREDICTIVE OF
IMPENDING SEIZURE ACTIVITY.
ON THIS LADERAL VIEW X-RAY, NOTE
THE PULSE GENERATOR IMPLANTED IN
THE PATIENT'S SKULL AND THE
LEADS ASSOCIATE WIFED THIS
DEVICE.
THE EARLIER VERSION OF THIS
TECHNOLOGY FROM NEUROPACE
CORPORATION, THAT IS, THE MODEL
3 NS-300 M IS LABELED MR-UNSAFE.
THE MORE RECENT VERSION, THE
MODEL THE RNS-320 IS 1.5 TESLA
FULL BODY ELIGIBLE WITH DEFINED
CONDITIONS OF SCANNING, THUS
PERMITTING PATIENTS TO BENEFIT
FROM THE DIAGNOSTIC CAPABILITIES
AFFORDED BY MRI.
PLEASE NOTE THAT THE RESPONSIVE
SYSTEM COMES WITH A CHECK LIST
AND WHEN TO BE USED, 1 TO USED
BY NEUROLOGY AND THE OTHER TO BE
USED BY RADIOLOGY, THE USE OF
THESE CHECK LISTS INSURE THAT
THE PATIENT IS ELIGIBLE TO
UNDERGO MRI AND THERE IS
COMPLIANCE WITH MRI RELATED
CONDITIONS FOR PATIENT SAFETY.
MED TRONNIC HAD THE FIRST FINE
SALIVA--SALIVA CORD STIMULATION
OR SCS DEVICES ON THE MARKET.
THESE EARLY DEVICES WERE LIMITED
TO US USE OF 1.5 TESLA ONLY AND
USING A TRANSMIT RECEIVE HEAD
COIL ONLY.
TECHNOLOGICAL ADVANCES HAVE
RESULTED IN POST GENERATOR,
LEADS ELECTRODES AND PROGRAMMERS
THAT ARE ARE USED FOR NEURAL
STIMULATION SYSTEMS WHICH IS
PERMITTED AND EXPANSION IN THE
TYPES OF MRI EXAMS THAT ARE
POSSIBLE FOR PATIENTS WITH THESE
ACTIVE DEVICES.
FOR EXAMPLE, THE SURE SCAN MRI
PLATFORM FROM MED TRONNIC THAT
IS USED FOR SPINAL CORD
STIMULATION SYSTEMS INCORPORATES
A FEATURE REFERRED TO AS FULL
BODY ELIGIBLE THAT ENABLES MRI
TO BE PERFORMED USING THE
TRANSMIT BODY COIL SO THAT ALL
BODY PARTS OF THE PATIENTS MAY
UNDERGO MRI EXAMS.
SPINAL CORD STIMULATION SYSTEMS
FROM OTHER COMPANIES SUCH AS
BOSTON SCIENTIFIC, NEVRO,
ST. JUDE MEDICAL OR ABBOT
SIMILARLY HAVE DEVICES LABELED
MARE RI CONDITIONAL IN FACT SOME
OF THESE HAVE LABELING THAT
PERMIT THE USE OF 3 TESLA
SCANNERS.
BOSTON SCIENTIFIC USES THE SO
CALLED IMAGE READY PLATFORM FOR
MR CONDITIONAL SPINAL CORD
STIMULATION SYSTEMS.
BEFORE SCANNING THE PATIENT AT
1.5 TESLA, THERE MUST BE
CONFIRMATION OF THE ACCEPTABLE
PULSE GENERATOR, EXTENSIONS, AND
LTD.S WHICH CAN BE FACILITATED
BY USING THE CHECK LIST PROVIDED
IN THE PRODUCT LABELING.
THE [INDISCERNIBLE] STIMULATION
SYSTEM HAS SPINAL CORD
STIMULATION AS WELL AS
PERIPHERAL NERVE STIMULATION IN
ORDER TO TREAT CHRONIC PAIN.
IT HAS IMPLANTED LEADS AND AN
EXTERNAL POWER AND STIMULATION
SOURCE.
THE PATIENT CAN BE SCANNED AT
1.5 OR 3 TESLA, AND THE
ACCEPTABLE WHOLE BODY SAR
DEPENDS ON THE PERIOD PART
THAT'S UNDERGOING IMAGING.
AS FAR AS THE MR CONDITIONING
LABELING IS CONCERNED, THERE'S
AN INDICATION THAT THE TEX
TERNAL COMPONENT MUST BE
REMOVED.
NO PART OF THE IMPLANT IS
ALLOWED WITHIN THE TRANSMITTED
RF ENEMBRYONIC STEMY AND THE
PEASHT MUST BE CONSCIOUS TO
NOTIFY THE TECHNOLOGIST IF
THERA'S ANY PROBLEM OR
UNDESIRABLE SENSATION FELT BY
THE INDIVIDUAL.
NOW LET'S TAKE A LACK AT A
DIFFERENT NEUROMODDULATION
CONFIGURURATION, NAMELY THE
VERSION THAT USES AN EXTERNAL
STIMULATION AND POWER SOURCE IN
COMBINATION WITH AN IMPLANTED
LEAD.
AN ADVANTAGE OF USING THIS
STRATEGY FOR NEUROMODDULATION IS
A FACT THAT CERTAIN COMPONENTS
ARE ELIMINATED SUCH AS IMPLANTED
POST GENERATORS AND LEAD
EXTENSIONS, PLUS, LONGER LEADS
ARE TYPICALLY NOT REQUIRED.
THESE FEATURES DECREASE
IMPLANTATION PROCEDURAL TIME
LOWER THE RISK OF INFECTION, AND
REDUCE THE OVERALL COSTS
COMPARED TO A CONVENTIONAL
NEURAL MODULATION SYSTEM.
CONVENTIONAL NEURAL MODULATION
SYSTEMS USED FOR FINE
SALIVA--SALIVA CORD STIMULATION
TYPICALLY HAVE IMPLANTED POST
GENERATORS WHICH ARE RATHER
BULKY AND MAY CAUSE TISSUE
DAMAGE AND OTHER PROBLEMS.
NEW TECHNOLOGY HAS BEEN
DEVELOPED FOR FINE SPAL CORD
STIMULATION THAT ALLOWS THE USE
OF AN EXTERNAL WEARABLE ANTENNA
AND POWER SOURCE THAT
COMMUNICATES WIRELESSLY WITH THE
RELATIVELY SHORT LEAD.
THIS UNIQUELY DESIGNED ACTIVE
DEVICE CALLED THE FREEDOM FOR
SCS SYSTEM IS FROM STIMWAVE AND
IT IS LABELED MR CONDITIONAL AT
1.5 AND 3 TESLA.
A NEURAL MODULATION SYSTEM
DESIGNED TO TREAT THREAP APNEA
IS DESIGNED FROM
[INDISCERNIBLE].
THEY STIMULATE THE NERVE IN AN
AIR WAY IN AN OPEN POSITION
WHILE THE PATIENT SLEEPS.
IT'S IMPORTANT TO NOTE THAT THE
APPROVED LABELING IS DIFFERENT
IN THE US VERSUS OUTSIDE THE
U.S., LET'S TAKE A LOOK AT THE
MR CONDITIONAL LABELING FOR THE
U.S., FIRST, STIMULAR TO OTHER
NEUROMODDULATION SYSTEMS WITH
EXTERNAL COMPONENTS, THE TEX
ERNETAL PARTS NAMELY THE
ACTIVATION CHIP AND DISPOSABLE
PATCH ARE NOT ALLOWED TO BE IN
CONTACT WITH THE PATIENT DURING
MAGNETIC RESONANCE IMAGING.
MRI XASMS CAN BE PERFORMED AT
EITHER 1.5 OR 3 TESLA, DIFFERENT
WHOLE BODY SARs AND SCANNER
ITERATIONS ARE USED DEPENDING ON
THE BODY PART THAT IS UNDERGOING
IMAGING AND IT'S IMPORTANT TO
NOTE THAT THE LABELING HAS A
POST OP WAIT PERIOD OF 6 WEEKS
AFTER IMPLANTATION OF THE
STIMULATOR THAT NEEDS TO
TRANSPIRE BEFORE PERFORMING MRI
ON THE PATIENT.
FINALLY AN EXTREMELY INTERESTING
NEUROMODDULATION SYSTEM WITH AN
IMPORTANT CLINICAL APPLICATION
IS THE ECOIN PERIPHERAL NEURAL
STIMULATOR FROM [INDISCERNIBLE]
TECHNOLOGIES, THIS DEVICE
PROVIDES STIMULATION OF THE
TIBIAL NERVE VIA A COIN SHAPED
IMPLANT AND USED TO TREAT
URGENCIUREINARY INCONTINENCE OR
UIIIN PATIENT WHO IS HAVE HAD
INADEQUATE RESPONSES TO OTHER
REGIMEN SPECS.
THE MRI LABELING FOR THE ECOIN
STATES IT IS UNSAVE TO HAVE THE
PATIENTS LOWER LEG WITH THE
IMPLANT PLACED IN THE MR SYSTEM.
NOTABLY, THE ECOIN MUST BE
POSITIONED AT LEAST
20-CENTIMETERS FROM THE EDGE OF
THE BORE OF THE SCANNER TO
INSURE PATIENT SAFETY.
FURTHER MORE THE IFU INDICATES
THAT THE EFFECT OF THE ECOINOT
OPERATION OF OTHER IMPLANTED
DEVICES SUCH AS CARDIAC
IMPLANTS, OTHER NEURAL
MODULATION SYSTEMS, AND
IMPLANTABLE DRUG PUMPS IS
UNKNOWN AND THERE MAY BE POETIC
TEBTIAL INTERFERENCE ISSUES.
THIS CONCLUDES MY PRESENTATION,
THANK YOU VERY MUCH FOR YOUR
ATTENTION.
I LOOK FORWARD TO OUR UPCOMING
QUESTION AND ANSWER SESSION.
>>SO THIS WAS THE PRESENTATION
FROM DR. SHELLOCK, HE DIDN'T
WRITE HIS E-MAIL BUT YOU CAN
FIND IT IN THE PROGRAM.
SO NOW WE ARE GOING TO GO
FORWARD WITH THE ORAL SESSION
FOR THE ABSTRACTS.
SO THE FIRST IS GRANT BAKER FROM
THE MED INSTITUTE IN WEST
LAFAYETTE, INDIANA AND THE TITLE
IS FEASIBILITY OF A SIMPLIFIED
VIRTUAL HUMAN ANATOMY FOR
DETERMINING RF-INDUCED HEATING
ACTIVE IMPLANTABLE MEDICAL
DEVICES.
>>THANK YOU FOR THE
INTRODUCTION.
CAN YOU HEAR ME OKAY. THERE
HAVE BEEN A COUPLE TALKS TODAY
THAT HAVE TALKED ABOUT DEVICES
SPECIFICALLY IN NEURAL
MODULATION AND THE DOCTOR'S TALK
THAT I THINK WAS JUST PRESENTED
THERE, GAVE A PRETTY GOOD
BACKGROUND.
I THOUGHT I WOULD START WITH A
LITTLE BIT OF A BACKGROUND AS
WELL.
THERE'S 2 MAIN CATEGORIES OF
IMPLANTED DEVICES IN TERMS OF
MRI SAFETY, THE FIRST 1 IS
PASSIVE IMPLANTABLE MEDICAL
DEVICES THOSE CAN BE ANYTHING
FROM CARDIOVASCULAR STINTS AND
HEART VALVES TO YOUR LARGER
ORTHOPEDIC DEVICES LIKE BONES R
SCREWS OR FULL HIP PROSTHESIS
AND THESE HAVE 4 MAIN SAFETY
CONCERNS WITH THOSE DEVICES,
BASICALLY THE DEVICE WILL MOVE
AS IT GOES THROUGH THE SCANNER
OR WILL IT TRY TO ORIENT WITH
BEING OUT IN THE FIELD WHEN IT'S
AN ISO CENTER, MRIMMAGE ARTIFACT
WHICH IS NOT A DIRECT PATIENT
SAFETY CONCERN BUT MORE OF A
SOMETHING TO KNOW FOR PHYSICIAN
LOOKING AT THE IMAGE, HOW MUCH
IT WILL DISTORT THE IMAGE AND
THEN RF INDUCED HEATING WHICH IS
THE RF COIL, OR THE RADIO FREE
RADICALS IMENSY COIL OR THE
SCANNER WILL CREATE AN ELECTRIC
FIELD THAT MIGHT FEED A TISSUE
SURROUNDING THE DEVICES.
SO THE SECOND CATEGORIES IS
ACTIVE IMPLANTABLE MEDICAL
DEVICES OR AIMS, AND THOSE ARE
THE SAME SAFETY CONCERNS AS
PASSIVE DEVICES ALONG WITH
ADDITIONAL 1S YOU SLEEP APNEA
AND OBESITYY AT THE BOTTOM
THERE, MAINLY DOING WITH
UNINTENDED STIMULATION AND
DEVICE MALFUNCTION BUT FOR THIS
TALK, I WILL FOCUS ON RF INDUCED
HEATING BECAUSE AS SOME OF THE
TALKS EARLIER HAVE HIGHLIGHTED,
IT'S A VERY INVOLVED TEST METHOD
AND IT BE VERY EXPENSIVE FOR
DEVICE MANUFACTURES TO EVALUATE.
SO FOR RF INDUCED HEATING AND
MANAGEMENT, THEY'VE MADE THIS A
FAIRLY STRAIGHT FORWARD PROCESS,
TAKE THE PROSTHESIS ON THENY ON
THE LEFT FOR EXAMPLE, WHERE
THERE'S MULTIPLE
CONFIGURURATIONS ON THE
PORTFOLIO.
SIMULATION ALLOWS TO YOU
UVALENTINEDUATE HUNDREDS OF
DIFFERENT PERMIAITATIONS OF THAT
DEVICE IN THAT PRODUCT BEFORE
YOU TO SEE WHAT THE WORST CASE
HEATING WOULD GIVE YOU AND THEN
YOU CAN TEST THAT AT 1
CONFIGURURATION IN A GEL F2182
AND THEN REPORT THOSE RESULTS
BUT IT'S NOT AS STRAIGHT FORWARD
FOR ACTIVE DERICES RICES--DEVICD
THAT IS FOR 2 MAIN REASONS, 1
IT'S CHALLENGING THROUGH MODEL
HIGH FIDELITY LEAD LIGHTERS IN
AIMDs, AND THAT IS BECAUSE YOU
HAVE A LOT OF MOVING PIECES IN
YOUR SIMULATION LARGE HERE AND
THE LEAD WIRES MAKE IT DIFFICULT
TO ACCURATELY MODEL THAT
EXCLUSIVELY AND THE SECOND
REASON IS THAT THE TANGENTIAL
FIELD OF EPHASE EFFECTS CAN
CAUSE THE HEATING OF AN AIMD ON
THE LEAD PATH THE LEAD WIRE
TAKES SO DEPENDING ON IF IT'S
STRAIGHT OR CURVED THIS CAN
CAUSE THE PHASE CENTER FOR
EXCELLENCE ON AGINGS CAN CAUSE
ADDITIVE HEATING OR IN SOME
INSTANCES CAN BE DESTRUCTIVE
HEATING THAT DECREASES THE
HEATING WHEREAS FOR A PASSIVE
DEVICE, YOU KNOW YOUR STRAIGHT
LONG THIN WIRE WILL BE YOUR
WORST CASE.
SO TO TACKLE THIS THERE'S A
COMBINED APPROACH OF PHYSICAL
MEASUREMENTSAs WELL AS
COMPUTATIONAL MODELS TO EVALUATE
HEATING OF AIMDs.
SO THIS IS CAUSE A TIER 3 OF THE
ISO 10974 DOCUMENT THAT $SHELL
COGNITIVE MENTIONED IN THE
PREVIOUS TALK AND THERE ARE 4
MAIN STEPS TO THIS.
SO THE FIRST STEP IS TO DEVELOP
AN ULTRA MAGNETIC MODEL OF THE
AIMD WIRE AND THAT'S WHAT YOU
SEE ON THE RIGHT.
IN THAT INSTITUTE WE USED THE
PROCESS OUTLINED BY ARC AND
DR. JOHN [INDISCERNIBLE] WHERE
YOU TAKE THE LEAD WIRE IN A LAG
ENVIRONMENT AND YOU EMIT A
FREQUENCY OF THE SCANNER OF
INTEREST, SO 1.5 OR TF3, OR 5,
OR 128, ALONG THE LEPGHT OF THAT
LEAD WIRE, AND IT INDUCES THE
TANGENTIAL ELECTRIC FIELD AND
YOU HAVE A PATROL THAT MEASURES
THE SCATTERED FIELD RESPONSE TO
THAT INDUCED FIELD.
--IN THE PHANTOM SO ON THE RIGHT
THERE YOU SEE 3 DIFFERENT PATHS
AND THOSE WOULD GIVE YOU KIND OF
A RANGE OF LOW TO HIGH
TEMPERATURE BECAUSE OF THOSE
PHASE EFFECTS THAT I MENTIONED,
AND THEN STEP 2 OF THAT IS YOU
WANT TO DIRECTLY RECREATE THOSE
LEAD PATHS YOU MEASURED IN
PERSON, OR IN PHYSICAL
EXPERIMENTATION IN A SIMULATION
SOFTWARE, WE USE COMPS, AND YOU
CAN IN MODELING THAT, CAN YOU
GET ANY POINT ON, THAT LEAD
WIRE, THE TANGENTIAL ELECTRIC
FIELD BACKGROUND TANGENTIAL
ELECTRIC FIELD IN THE PHANTOM
AND THEN COMBINING THOSE
MEASUREMENTS WITH THAT MODEL YOU
CALCULATE A PREDICT TD
TEMPERATURIZE AND YOU COMPARE
THAT PREDICTED TEMPERATURIZE
WITH YOUR PHANTOM
TEMPERATURIZES, AND THEN GET AN
AGREEMENT THAT VALIDATES YOUR
MODEL FROM STEP 1.
SO STEP 3 IS YOU WANT TO GET
HIGH WORST CASE FEEDING IN A
PHANTOM SO YOU WANT TO SEE WHAT
THE HEATINGS LIKE IN CLINICALLY
RELEVANT LEAD WIRE PATHS AND
THAT CAN BE EXTREMELY TIME
CONSUMING AND COMPUTATIONALLY
EXPENSIVE BECAUSE MOSTLY A LOT
OF DEVICES WILL HAVE SEVERAL
DIFFERENT CLIBICALLY USED LEAD
PATHS DEPENDING ON HOW MUCH
SLACK IS NEEDED OR WHAT
PHYSICIANS TEND TO LIKE TO USE
IT LIKE.
AND THEN YOU HAVE TO LOOK AT A
MULTITUDE OF DIFFERENT LANDMARKS
WITHIN THE SCALPER, MOVING THE
PATIENT THROUGHOUT ISO CENTER
AND EVALUATE SAFETY IN ALL THOSE
MARKS.
AND THEN STEP FOR IS JUST TAKING
THOSE MEASUREMENTSIC LOAMACY YOU
DID IN STEP 2 AND USING IT TO
CALCULATE IN VIVO HEATING SO
WHAT WE WANTED TO TO SEE IS CAN
WE KIND OF CUT DOWN THE TIME AND
COMPUTATIONAL EXPERIENCE THROUGH
3 SO THAT IT'S A QUICKER MORE
STREAMLINE PROCESS TO EVALUATE
AMP HEATING.
SO WHAT WE DID TO STUDY THIS IS
WE USED A DUKE VIRTUAL HUMAN
ANATOMY FROM THE [INDISCERNIBLE]
FOUNDATION AND WHAT YOU SEE ON
THE LEFT HERE IS THE FULLY
FEATURED DUDE WITH ALL ISES HIS
BONES, AND ORGANS, ET CETERA AND
EACH HAS ITS OWN MAGNETIC
PROPERTIES AND THEN YOU CAN SEE
WE MODELED A SPINAL CORD NEURAL
STIMULATOR DEVICE HERE IN THE
DUKE ANATOMY AND THEN WE TOOK
OUT ALL THE INTERNAL ORGANS AND
JUST HAD PLAIN GENERIC TISSUE ON
THE RIGHT AND THEN ASSIGN THAT
THE AVERAGE TISSUEOT MAGNETIC
PROPERTIES THAT YOU WOULD SEE IN
THE PHANTOM SO YOU'RE 4.7-METER
AND THEN PUT THAT SAME EXACT
LEAD PATH IN THAT VIRTUAL HUMAN
ANATOMY AND THEN WE LIKE STEP 3
HERE, MODELED THAT IN A COIL AND
COUNTED MULTIPHYSICS AND
MEASURED THE E10 MAGNITUDE AND
THE ETAN PHASE LONG THOSE PATHS
IN BOTH MODELS.
SO FOR THE RESULTS YOU CAN SEE
HERE ON THE LEFT, THE MAGNITUDE
OF ETAN AND THENOT RIGHT THE
PHASE OF ETAN, THE LEFT IS THE
FULLY FEATURED DUDE WITH ALL HIS
ORGANS AND THE THEN YOU HAVE
DUKE WITHOUT ANY INTERNAL ORGANS
YOU CAN SEE THEY HAVE GOOD
AGREEMENT AND WITHOUT INTERNAL
MORG ATS SIMPLIFIED MODEL
APPEARS TO BE A FILTERED VERSION
OF WITH INTERNAL ORGANS AND THE
REASON YOU SEE THAT IS BECAUSE,
BONE AS A MUCH LOWER ELECTRICAL
CONNECTIVITY THAN, YOU KNOW YOUR
AVERAGE TISSUE PROPERTIES SO YOU
KIND OF SEE THAT FLUCTUATION
BECAUSE THE FULLY FEATURED PATH
IS A LOT OF BONE WHEREAS THE
OTHER PATH IS NOT.
AND THEN, WE CALCULATED
TEMPERATURES LIKE YOU SEE FROM
THE STEP 2 AND APPROXIMATE 4 OF
WHEN I WENT OVER EARLIER.
AND YOU GET, YOU KNOW ONLY A
DEGREE AND A HALF DIFFERENCE
BETWEEN THE 2 MODELS AND I WANT
IT HIGHLIGHT THAT THESE AREN'T
NECESSARILY REALISTIC
TEMPERATURE RISES, WE USE THESE
ETAN MAGNITUDE VALUES WITH A
PREVIOUS VALIDATED TRANSFER
FUNCTION THAT WERE MEASURED FROM
THE COMMERCIALLY AVAILABLE
NEUROSTIMMULATOR.
SO WHAT ARE THE TAKE AWAYS FROM
THAT?
AS SHOWNOT PREVIOUS SLIDE, YOU
HAD VERY GOOD AGREEMENT BETWEEN
THE 2, TEMPERATURE RISES, FAIRLY
SIMILAR AND IN THE FUTURE WE CAN
KIND OF LOOK AT MULTIPLE,
MULTITUDE OF DIFFERENT PATHS AND
LANDMARKS TO MAKE SURE YOU STILL
GET THE SAME AGREEMENT.
SO WHAT DOES THAT MEAN GOING
FORWARD?
WE THINK IN THAT INSTANCE HERE
THAT THE SIMPLIFIED VIRTUAL
ANATOMY CAN BE USEDsA A
PRELIMINARY RESULTS, SO LIKE I
SAID, YOU'VE GOT A MULTITUDE OF
DIFFERENT LEAD PATHS AND
LANDMARKS THAT YOU NEED TO LOOK
AT SO MAB YOU START WITH YOUR
SIMPLIFIED HUMAN MODEL, TO LOOK
AT THE TEMPERATURE IN ALL OF
THOSE, YOU KNOW YOU PICK OUT A
HANDFUL OF YOUR HIGHEST
TEMPERATURE RISES AND THEN RERUN
THEM WITH THE FULL FEATURED
HUMAN ANATOMY AND IT WILL CUT
DOWN ON TIME AND COMPUTATIONAL
EXPENSE, WHILE STILL CAPTURING
THE HEATING AND THIS WILL KIND
OF LOWER THE BAR OR MAKE IT
EASIER FOR DEVICE MANUFACTURES
OF NEUROSTIMMULATORS AND OTHER
AIMS TO, YOU KNOW FOR THE DEVICE
BECAUSE IT WILL CUT DOWN ON COST
FOR THE TESTING HOUSES.
SO IF ANYBODY HAS ANY QUESTIONS
PLEASE REACH OUT TO ME, AT OUR
INSTITUTE WE DO A LOT OF SAFETY
EVALUATIONS SO I WOULD BE HAPPY
TO TALK TO YOU AND ANSWER ANY
QUESTIONS YOU HAVE.
THANK YOU FOR YOUR TIME.
>>[ APPLAUSE ]
>>SO ARE THERE ANY QUESTIONS?
SO I WILL ASK YOU SOMETHING, SO
WHY DO YOU WANT TO REDUCE THE
AMOUNT--I GET IT'S IMPORTANT FOR
THE CALCULATION, DO YOU NEEZ
THESE CALCULATIONS OR VALUES
ONLINE OR IN REALTIME BEFORE YOU
DO ANY SCANS OR WHAT IS THE
MOTIVATION?
I DIDN'T UNDERSTAND THE
MOTIVATION FOR YOURICISM
LIIFYING THE MODEL WHEN IS THE
PEOPLE HAVE TRIED SO HARD ALWAYS
TO MAKE THEM EVEN CLOSER TO
THE--
>>NO, THAT'S A GOOD QUESTION.
SO, AS YOU BRING UP THE FULL
FEATURED HUMAN ANATOMY MODEL IS
DEFINITELY THE BETTER PREDICTOR
OF WHAT HEATING WHICH AUTOMORE
FOR USE OF GETTING THIS
MULTITUDE OF SIMULATIONS AND
EVALUATIONS AS WAS BROUGHT UP IN
A PREVIOUS TALK IT'S A VERY
EXTENSIVE PROCESS, LOOK HOW TO
INDUCE HEATING SO TO KIND OF TO
QUICKEN THAT PROCESS SO THAT
IT'S CHEAPER FOR THESE DEVICE
MANUFACTURES AND DEVICES AND GET
LABELING DOWN WITHOUT
COMPROMISING THE RESULTS OF
THAT, BUT THEN YOU DON'T HAVE
SOME EXACT VALUES OR MAYBE VERY,
VERY SAFETY VALUES BUT THEY ARE
MAYBE TOO RESTRICTED AND THEN
SOME PEOPLE MIGHT NOT BE ABLE TO
GET A SCAN BECAUSE OF THOSE
VALUES.
EVEN SO THEY ARE NOT KIDDING SO
MUCH SO I GET IT THAT IT'S
IMPORTANT FOR THE COMPANIES BUT
I THINK TO GIVE ACCESS TO THE
FEEM WITH THE MRMAY NOT BE AS
GOOD BUT I DON'T KNOW THAT'S
JUST MY THEORY OF COURSE.
, YEAH.
>>SO I THINK THERE IS ANOTHER
QUESTION.
>>SORRY.
>>[INAUDIBLE QUESTION FROM
AUDIENCE ]
>>SO YOU'RE SAYING IN THE LEAD
TECH GOES THROUGH DIFFERENT
TISSUES AND NOT NECESSARILY
SURROUNDED BY DIFFERENT TISSUES?
>>[INAUDIBLE RESPONSE PRACTICES
AUDIENCE ]
>>SO THE LEAD PATH THAT WE LAID
OUT IN THE FULLY FEATURES KIND
OF GOES THROUGH THE SPINAL CORD
SURROUNDED BY THE VERTEBRAE
WHEREAS THE OTHER 1 WAS JUST
THROUGH AVERAGE TISSUE SO THESE
RESULTS SHOW THE COMPARISON OF
AIR DEVICE OR LEAD PATH THAT IS
SURROUNDED OR NOT SURROUNDED BY
A DIFFERENT TYPE OF TISSUE WE
DIDN'T LOOK AT A LEAD PATH THAT
WENT THROUGH A DIFFERENT TYPES
OF TISSUES BUT WE'RE NOT
FAMILIAR WITH A TON OF DIFFERENT
NEUROMODDULATION DEVISITINGS
THAT GO THROUGH BONE OR THROUGH
FAT, THROUGH FAT, OR THROUGH
BONE A GUESS, IT'S KIND OF
CAPTURED BY THE AFTERERAGE
TISSUE, SORRY THE QUESTION CAME
UP, THIS IS PRETTY GOOD.
KIND OF PRACTICAL OBSERVATION IS
LET'S TAKE TIME, WHAT'S A LONG
PROCESS FOR US IS PUT THE LEAD
PATH IN THE MODEL SNOT SO MUCH
ABOUT SIMULATION, BECAUSE
SIMULATION WANTS TO RUN LIKE
STAY THERE, 1.5, COUPLE COILS
THAT STAY THERE FOREVER, YOU GET
TO EXTRACT EFIELD, YOU DON'T
HAVE TO RERUN AGAIN AND AGAIN
BUT FOR THE LEAD PATHWAY, WE
HAVE TO BECAUSE YOU HAVE TO KNOW
THAT THE ANATOMY IS WITH THEM
SEGMENTED FULL MODEL BEFORE WE
CAN PUT THE LEAD PATHWAY IN,
OTHERWISE HOMOGENOUS LEAD
PATHWAY SO YOU START WITH A FULL
FULL MODEL IF YOU RUN SIMULATION
SO CAN YOU HAVE THAT SIMULATION
AND UNLESS YOU WANT TO DO
ONLINE, WHAT YOU THOUGHT?
>>YOU BRING UP A GOOD POINT,
FRAMING UP THE FULLY FEATURED
SIMULATIONS TAKE ANYWHERE FROM
DOUBLE TO TRIPLE THE TIME OF THE
JUST A MODERN SIMULATION, I
GUESS IF YOU OPEN UP THE
LANDMARKS AND EVERYTHING YOU
LOOK AT IT CAN TAKE MORE TIME SO
WE WERE JUST TRYING TO DECREASE
OVER ALL TIME IN COMPUTATIONAL
EXPENSE IN THAT WAY WITHOUT COMP
PROMISING RESULTS.
>>SO WE HAVE TO MOVE ON TO KEEP
THE PERFECT TIMES THAT WE HAVE
BEEN HAVING.
SO OUR NEXT SPEAKER IS DR. SAYIM
GOKYAR, HIS PRESENTATION IS
CNN-BASED RF SAFETY ANALYSIS OF
PASSIVE NEUROMODDULATION
IMPLANTS FOR PARALLEL
TRANSMISSION SYSTEMS AT 7 T.
>>HELLO, THANK YOU VERY MUCH
FOR THE KIND INTRODUCTION, THIS
IS SAYIM FROM THE UNIVERSITY OF
SOUTHERN CALIFORNIA.
I HAVE NOTHING TO DECLARE.
WHICH ALSO ALLOWS FOR HIGHER
SPATIAL OR TEMPORAL RESOLUTION.
AND HOWEVER IT COMES WITH
REACHES THE MORE FREQUENCY,
BEYOND THAT THERE IS ALSO A
HIGHER PLUGS AND SEGBREIGATION
FROM THE MAGNETIC SPHWRIEWKS
VARIATION DUE TO WAVE LENGTH
EFFECT BECAUSE AT 7 T STUFF FOR
EXAMPLE, WE HAVE GONE UP TO
12-CENTIMETERS FOR INVIEF O
APPLICATIONS, AND HIRE THE FIELD
STRENGTH USUALLY PERCEIVED FOR
IMPLANTS, BUT FOR DBS STUDIES WE
HAVE SOME RECENT LITERATURE BUT
COULD BE SOMETHING DANGEROUS AS
WELL.
SO AT THIS PONT WE ASK THE
FOLLOWING RESEARCH QUESTION,
WOULD IT BE POSSIBLE TO PREDICT
THE LOCAL DISTRIBUTION OR LOCAL
SIDE VARIATION FROM CLINICALLY
IN CASE OF DATA IMPLANTS WHAT I
MEAN BY CLINICAL DAT IS THE B1 +
DISTRIBUTIONS OR IMAGING AGAIN,
THERE ARE--SORRY DISTRIBUTION,
THE FIRST IS THE METHOD ACTUALLY
IN WHICH MOST SCANNERS IMP
KREMENTED FALL THE OBSERVATION
POINTS, IT CALCULATES THIS
MAXIMUM OF THE LOCAL SIZE
VARIATION FOR SOME ESTIMATION
PENALTY BUT IT DOESN'T GIVE YOU
ANY LOCAL DISTRIBUTION.
THE OTHER TEAM METHODS PROVIDE
SOME USE OF PREDICTION MAPS, THE
SECOND 1 USES B1 MAPS, THE
FOURTH 1 REQUIRES SOME MR IMAGE
SINCE IT'S ALMOST IMPOSSIBLE TO
LOCAL IRBs ARE YOUR PATIENTS
AND WEICIDED TO TEST THE SEC
SECOND METHOD BY USING
SIMULATION METHODS SO WHAT WE
HAD DONE IS WE HAD PARTICIPANTS
WE SCANNED THEM BY USING 1 METER
RELIEWGZ AND WE USE OF COURSE
SPN CALLED BY THE TOOL BOX, THE
TOOL BOX AND WE USE THE BRAIN
CSF AND EXTRACT OF THOSE TOOL
BOXES WE THEN SEGMENTED TO OTHER
IMPORTANT TISSUES MAN YELLLY, MY
FIRST SEGMENTATION TOO TOOK ME 2
WEEKS SINCE I DON'T HAVE MEDICAL
BACKGROUND I HAD TO GO THROUGH
ALL THE BRAIN [INDISCERNIBLE].
AND NOW DAYS I CAN FINISH IT IN
1 OR 2 DAYS BUT THE MANUEL
SEGMENTATION IS STILL NOT
PERFECT BUT THIS IS THE ONLY 2 I
CAN DO AT THE MOMENT.
AND THEN I GO BACK TO THE
SOFTTISSUE MASK AND SEGMENTED
EFFECT AND MUSCLE, HERE THE
CRITICAL THING TO SOME TISSUES
HAVE REALLY HIGH CONNECTIVITY
SUCH AS CSF AND BLOOD, THEY PLAY
A CRITICAL ROLE IN THIS
DISTRIBUTION BECAUSE SAR IS
STRONGLY CORRELATED TO THE
TISSUE PARAMETERS AS WELL.
SO HERE ARE THE SEGMENTED
ANALYSIS FROM THE TOOL BOX THAT
WE HAVE IN THE SIM 4 LIFE
SIMULATION SOFTWARE AND THE
FIRST MOMENT IN THIS
PRESENTATION, THIS IS THE
GENERATED 3D HEAD MODEL, AND IT
SHOULD LOOK LIKE ME.
THIS IS MY DATA AND I HOPE IT'S
TRUE.
WE DON'T PUT THESE HEAD MODELS
INTO THE MRI COILS THAT WE HAVE
DESIGNED FOR 7 TESLA, AND OF
COURSE, SIMULATE THEM.
THEY WILL ALSO INTRODUCE OUR
SUPER STARS OF THE SAFETY FIELD
ELA AND DUKE THESE 2 MODELS ARE
QUITE COMMON, WE ALWAYS START
OUR EXPERIMENTS WITH THESE 2, WE
PLACED THEM CLOSE AS A PERFECT
CONDUCTORS JUST TO SIMPLIFY
CALCULATIONS, ALSO THE IPG
SPECIAL MODELED AS A RECTANGULAR
PEC WHICH ALSO SHOWS THE DBS
ELECTRODES ACTUALLY AND CLOSE
PLACED TO THE CHEST UNDER THE
SKIN.
WE REPEATED THIS FOR OTHER
SUBJECT DATA AS WELL.
THE GOOD TECHNOLOGY TRANSFER WAS
WE HAD THE MRI FOR OUR SUBJECTS,
THAT'S WHY IT WAS MUCH EASIER TO
FIND THE THALAMUS AND TRACE THE
WIRES, DECIDE ON THE TRAJECTORY.
NOW WHAT WE HAVE DONE OF COURSE
IS WE RUN MAGNETIC STIMULATIONS,
WE GENERATED, B1 PLUS MAPS GIVEN
FACE CONFIGURURATION AND THEN WE
CALCULATED THIS 10 PRM AVERAGE
[INDISCERNIBLE] AS CAN YOU SEE
WE REPEATED THIS FOR DIFFERENT
SUBJECTS, WITH DIFFERENT COIL
ARCHITECTURES.
SO HERE, EITHER WE USED AN HNPTX
COIL OF ELEMENTS OR FOR EXAMPLE,
SOMETIMES WE USE HNO DRIVEN
[INDISCERNIBLE] OR THIS 1.
AS YOU CAN SEE, FOR SOME PHASE
SETTINGS AND SOME SUBJECTS WE
CAN SEE CLEAR DEPLETING OF TPS
ELECTRODES HOWEVER FOR SOME
CONDITIONS WE DON'T SEE
COMPETING CLEARLY AND WE HAVE
THE HOT SPOT SLOWSURE TO THE
SKIN, SO PTX INDUCES GREATER
FLEXIBILITY FOR PEELED
UNIFORMITY ALSO IT HAS SOME
COMPLEXITY, WHAT WE HAVE DONE IS
WE REPEATED THIS STIMULATIONS,
BUT ITERATIONS FOR 200 RANDOM
MACHINE SETTINGS AND WE
GENERATED A DATA SET OF OVER
1000 DATA.
ON THE CONVOLUNTEERSUTIONAL
NEURAL NETWORK SIDE, WE CONTHAT
THE CONVENTIONAL 2 D STRUCTURES
PROCESS INPUT IMAGE THROUGH THE
SLICES AND TRY TO PREDICT
CORRESPONDING THROUGH THE SAR,
BUT WE STARTED WITH THESE BUT
THERE WERE INHERENT CHALLENGES
SO WE DOWN SHIFT TO THE PICTURES
AS YOU CAN SEE, THE NETWORKS
PROCESS THE WHOLE DATA AT ONCE
SO IT CAN CORRELATE THE
DISTRIBUTIONS IN 3 DIMENSIONS,
IT DOESN'T HAVE TO SOMEHOW TRY
TO CORRELATE THE [INDISCERNIBLE]
DEVICES.
IT IS ALSO QUITE FAST BECAUSE
THEY'RE DONE ON GPUs, IT
DOESN'T HAVE TO READ AND WRITE
EVERY SLICE FOR EVERY ITERATION.
DURING TRAINING WE HAVE SEEN 30
TIMES ACCELERATION AND ALMOST
INTERESTING 10 TIMES
[INDISCERNIBLE].
SO RESULTS ARE OVER 90%, THESE
ARE IMPRESS OF IF YOU ARE NOT
FROM A COMPUTER DOMAIN, THEN WE
SWITCHED OUR MODELS AND REPEATED
ALL THE TESTS AND WE HAVE SEEN
THAT THE STRUCTURAL INDEX MATRIX
AND WE TESTED SOME OTHER
COMPUTER VISION FEATURES, WE
HAVE SEEN THAT THESE RESULTS ARE
EVEN MORE IMPRESSIVE, 95%, BUT
WHAT WE HAVE DONE IS WE ARE
LIMITED OUR FIELD TO ONLY
CATAREGION, SO, WE JUST REMOVE
THE BACKGROUND SINCE IT DOESN'T
INCLUDE ANY DATA.
WE ARE SEEING THAT STRUCTURAL
SIMILARITY IN THE METRIC IS
DECREASING SOPHISTICATED WE HAVE
FOUND THAT 1 WAY TO INCREASE THE
DATA IS INCLUDE BACKGROUND.
SO IT WILL JUST GO UP EVEN
THOUGH YOU ARE NOT PREDICTING
THE RESULTS QUITE WELL, AND HENS
OUR FIRST CONCLUSION COMES AT
THIS POINT.
WE THINK THAT THE FEATURE FOR
THE METRIC IS RELIABLE AND MORE
ROBUST, BECAUSE IT'S INDEPENDENT
FROM THE BACKGROUND AND AS CAN
YOU SEE FOR VOXEL OR FOR 3D DATA
ALMOST ALL OF THE PIXELS ARE
EMPTY.
SO, THIS IS 1 OF OUR CONCLUSION.
AND THE LAST MOMENT OF TRUTH, IF
YOU ARE PREDICTING LOCAL SIDE
DISTRIBUTION THEN YOU SHOULD BE
ABLE TO PREDICT MAX MULL VALUES
OF EACH ITERATION AS WELL AS
INDICATES OF MUTUAL OBSERVATION
POINTS.
AS CAN YOU SEE IN THIS HERE, OUR
FINDINGS, THIS SAYS THAT WE CAN
PREDICT THE INPUT VALUE, WHICH
ALMOST 99% ACCURACY, BUT, THIS
IS ALSO YOU KNOW MISLEADING AS
YOU SEE, THE COENTIOUS FICIENT
IS 0.75.
FOR EXAMPLE, FOR A STOP VALUE OF
0.8-WATTS PERKILOGRAM VALUE, WE
MAY PREDICT THE MAXIMUM VALUE OF
0 PBT 7 OR SOMETIMES MAYBE 1 SO
WE MIGHT BE OVERESTIMATING OR
UNDERESTIMATING THE RESULT.
THIS TELLS US THERE IS STILL
SOME WAY OR THERE IS STILL SOME
ENERGY TO BE SPEND ON THE
RESEARCH WORK AS WELL.
SO IN CONCLUSION, WE HAVE SEEN
THAT THE CNN BASED MODELS CAN BE
USED TO PREDICT DISTRIBUTION
EVEN WHEN YOU HAVE DBS
ELECTRODES AND THEY ARE QUITE
FAST.
ENTIOUS SPECIALLY IF YOU USE 3D
METHODS AND FEATURE STIMULATING
METRIC IS MORE ROW BUST AND
RELIABILITY THAN THE SECURITY
METRIC BUT WE STILL HAVE BASE TO
GO BECAUSE I HAVE THE NEED TO
INCREASE OUR RELIABILITY OF OUR
REDICTIONS AND THERE ARE
LIMITATIONS OF COURSE, IT'S
ALMOST IMPOSSIBLE TO CONVINCE
LOCAL IRBs NOWADAYS AT LEAST
FOR SCANNING LIMITATIONS FOR
DAILY BASIS AT SCANS.
ALSO WE CAN'T GENERATE TRAINING
DATA FROM THE B1 MAPS FOR THE
SAME REASON, THE LAST THING IS
ACTUALLY DEPENDENCY OF SAR,
SAR IS NOT DEPEND TONIGHT B1,
BUT IT'S CALCULATED BY USING
TISSUE PROPERTIES MULTIBIED BY
ELECTRICAL TISSUES AND THE FIELD
CAN BE CORRELATED UP TO CERTAIN
DEGREE, THAT'S WHY WE HAD SOME
LIMITATIONS ON THAT PART AS
WELL, B1 + IS ON THE FIELD WE
CAN GET FROM THE SCANNER.
OF COURSE WE ARE TRYING
DIFFERENT COIL TYPES AND
DIFFERENT LANDMARKED LOCATIONS
FOR THE PATIENT AND THESE ARE
THINGS THAT SHOULD BE STUDIED.
WITH IT BEING SAID, I WOULD LIKE
TO ALSO ACKNOWLEDGE THE GROUP
MEMBERS OF OUR [INDISCERNIBLE]
AND OUR FUNDING RESOURCES AND
THANK YOU FOR JOINING ME ON THIS
PRESENTATION AND I WILL BE HAPPY
TO ANSWER ANY QUESTIONS THAT YOU
MAY HAVE.
THANK YOU.
[ APPLAUSE ]
>>I SEE THERE ARE QUESTIONS
THERE, PLEASE?
>>THE [INDISCERNIBLE], IS THAT
MEASURED AT LOCAL SAR AROUND
ELECTRODE, WHAT IS THE
[INDISCERNIBLE]?
>>SIMULATIONS 3D
SAR DISTRIBUTION FOR THE MODEL,
FOR A GIVEN PHASE SETTINGS, SO
YOU USE THAT DISTRIBUTION AS THE
GROUND PUT AND YOU NETWORK TO
PREDICT THAT BY LOOKING AT THE
B1 + ONLY.
SO FOR EXAMPLE, HERE, THE GROUND
FRUIT MEANS THAT NOT JUST FOR
THIS SLICE, BUT FOR ALL THE
SLICES OF THIS MODEL AT THIS
PHASE FEEDING SCHEME AND LAYOUT
AND WE ARE TRYING TO PREDICT
EACH AND EVERY SLICE.
>>BASED ON SEGMENTATION OR
SIMULATIONS?
>>YES, THESE ARE SIMULATIONS OF
COURSE.
, OKAY.
>>INTERESTING TALK, SO I HAVE
QUICK TECHNICAL QUESTION.
SO WHEN YOU WERE TRAINING YOUR
DEEP NETWORK, YOU SAY IT'S
[INDISCERNIBLE] SO DID YOU SOW
IN THE ENTIRE 3D IMAGE OR DID
YOU DO A SAMPLE PATCH BECAUSE MY
EXPERIENCE YOU KOOBT HOLD THE
ENTIRE IMAGE.
>>FOR 1 IMAGE ACTUAL WE JUST
CONVERTED THEM TO NIFSI, AND WE
HAVE A 64 BY 64 RESLIEWGZ SO THE
GP I USED WAS THE TI, 1660.
IT'S NOT THE HIGH END STUFF BUT
IT WAS ABLE TO COMPUTE THIS.
HOWEVER I WASN'T ABLE TO COMPUTE
1 MILLIMETER VOXEL RESOLUTION
FOR A RESPONSE TO 128 BY 128, BY
128.
IT WAS QUITE MUCH.
>>SO YOU CAN A LITTLE BIT.
>>YEAH, JUST DOWN SAMPLED TO
64.
>>OH BY 64.
>>YEAH, IT WAS 64, BY 64, BY
EXPOR AND IT WAS STILL WORKING
GREAT.
>>OKAY.
>>THE AFTERERAGE STAR HAS A
VOXEL SIDE SIZE OF AROUND
2-CENTIMETER FOR A 10-GRAM
TISSUE, SO RESOLUTION OF
2-MILLIMETER IS STYLE QUITE GOOD
TO PREDICT ASAR.
>>GOOD TO KNOW, THANK YOU.
>>DO WE HAVE ANYMORE QUESTIONS?
I'M JUST GOING TO ASK A INQUIRY
SHORT 1.
IF YOU WANT TO HAVE THE B1
PLASMA INPUT INTO YOUR MODEL AND
YOU WILL HAVE TO NEED TO SCAN
THE PEOPLE AND IF IT'S NOT SAFE
THEN HOW ARE YOU GOING TO SOLVE
THAT PROBLEM.
>>ACTUALLY, ORIGINALLY WE ARE
DEVELOPING THIS PROBLEM FOR THE
REGULAR CLINICAL USE SO DBS WAS
JUST SOMETHING WE WANT TO
INVESTIGATE, IF IT'S POSSIBLE
AND IT SEEMS THAT OUR FINDINGS
SUPPORT IDEA THAT FIRST THE 7
TEST MIGHT NOT BE AS DANGEROUS
AS OPPOSED TO PERCEIVED
PROBLEMS, THE SECOND 1 IS 1 DAY
IF WE CAN SCAN PATIENTS WITH
DBS, THERE MIGHT BE A WAY TO
REDICT LOCAL SAR WITH OUT THESE
SEGMENTATIONS, A COUPLE HOURS OF
STIMULATION AND UNDERSTAND IF
IT'S SAFE OR NOT AND KAN--KANA
THE PATIENTS TO DO REALLY
SEQUENCE FOR THE HIGHER
LIMITATION AND THEN IS A KIND OF
WORKING PROGRESS AND PROOF OF
CONCEPT.
>>SO IF THERE ARE NO MORE
QUESTIONS I WILL CLOSE THE
SESSION AND THANK YOU FOR YOUR
ATTENTION AND WE WILL SEE EACH
OTHER, I THINK IT'S AT--IN HALF
AN HOUR, ABOUT HALF AN HOUR, 5
TO 4.
THANK YOU.
OR INTERMITTENT STIMULATION,
ARE THOUGHT TO IMPACT THIS
EXCITATORY INHIBITORY BALANCE IN
DIFFERENT WAYS.
PROTON MAGNETIC RESONANCE
SPECTROSCOPY IS ONE TOOL THAT
HAS BEEN USED TO CHARACTERIZE
CHANGES IN NEUROMETABOLITE
CONCENTRATIONS IN SPECIFIC
REGIONS OF INTEREST.
EARLIER THIS YEAR, A GREAT
SYSTEMATIC REVIEW OF RTS
STUDIES, RTMS SPECTROSCOPY
STUDIES IN PATIENTS WITH
DEPRESSION.
FOR OUR STUDY, OUR GOAL WAS TO
SYNTHESIZE A BROADER COLLECTION
OF LITERATURE IN A QUANTITATIVE
WAY.
WE WANTED TO LOOK AT STUDIES
THAT PERFORMED SPECTROSCOPY
BEFORE AND AFTER AN RTMS OR TBS
INTERVENTION IN PATIENT
POPULATIONS OR HEALTHY CONTROLS.
FOR DATA COLLECTION, WE
INITIALLY IDENTIFIED OVER 300
PAPERS, THEN SCREENED FOR
STUDIES THAT INCLUDED AN MRS
SCAN BEFORE AND AFTER THE TMS
INTERVENTION.
BEFORE ANALYSIS, WE ALSO
EXCLUDED EFFECTS OF METABOLITES
WITH FEWER THAN FIVE EFFECTS.
WE ENDED UP WITH A DATASET OF 23
STUDIES AND 115 EFFECTS WITH A
TOTAL OF 374 PARTICIPANTS, ABOUT
HALF OF WHOM WERE FEMALE AND AN
AVERAGE AGE OF 36 YEARS.
TODAY I'M GOING TO FOCUS ON THE
EXCITATORY AND INHIBITORY
NEUROTRANSMITTER RESULTS.
SO FIRST, THIS IS A PLOT OF GABA
EFFECTS SEPARATED BY A STANDARD
RTMS PROTOCOLS AT THE TOP AND
TBS PROTOCOLS AT THE BOTTOM.
WE CHOSE TO SEPARATE BY TMS
PROTOCOL BECAUSE THE BASIC
FEATURES SUCH AS SCAN TIME ARE
QUITE DIFFERENT AND THE
MECHANISM OF ACTION OF THAT I DA
BURST IS DIFFERENT.
WE HIGHLIGHT THE MAIN EFFECT FOR
GABA AT THE BOTTOM.
YOU CAN SEE GABA IS NOMINALLY
ELEVATED AFTER STANDARD RTMS
INTERVENTION BUT NOT AFTER TMS.
FOUR OF OUR 5TBS EFFECTS HERE
ARE ACTUALLY FROM THE SAME
PAPER, AND I ALSO LUMPED
TOGETHER INTERMITTENT AND
CONTINUOUS TBS DUE TO LIMITED
SAMPLE SIZE.
THIS NEXT PLOT SHOWS ANALYSIS
RESULTS FOR GLUTAMATE PLUS GLX.
GLX IS A COMBINED SIGNAL OF
GLUTAMATE AND GLUTAMINE.
SO I LUMPED THEM TOGETHER JUST
TO GET A STRONGER SIGNAL FOR THE
EXCITATORY NEUROTRANSMITTER
GLUTAMATE.
YOU CAN SEE HERE THERE'S A
MARGINAL ELEVATION OF GLUTAMATE
PLUS GLX AFTER STANDARD RTMS
SIMILAR TO GABA, BUT THERE ARE
NO SIGNIFICANT EFFECTS AFTER TBS
INTERVENTION.
YOU CAN ALSO SEE AT THE VERY
BOTTOM THAT THERE'S AN EFFECT
TRENDING TOWARDS SIGNIFICANCE
FOR THE OVERALL MAIN EFFECT FOR
GLUTAMATE PLUS GLX.
SO HERE I JUST WANTED TO
HIGHLIGHT THOSE SUMMARY EFFECTS
FOR CONVENTIONAL RTMS VERSUS
TBS.
WE SEE THAT AFTER THAT AS
MEASURED BY SPECTROSCOPY AT 3T
AS ALL THESE STUDIES WERE DONE,
BOTH GLUTAMATE AND GABA ARE
ELEVATED AFTER CONVENTIONAL RTMS
PROTOCOLS BUT NOT AFTER TBS.
SO WE CAN SPECULATE AS TO THE
CELLULAR MECHANISMS OF THIS
EFFECT.
IT MAY HAVE SOMETHING TO DO WITH
UPREGULATION OF ENZYMES IN THE
GLUTAMATE GABA PATH CYCLE BUT
I'D LOVE TO HEAR YOUR THOUGHTS
AS TO WHY THIS MIGHT BE
HAPPENING TOO.
THIS NEXT RESULT COMPARES
SUMMARY EFFECT SIZES FOR GABA
AND GLUTAMATE PLUS GLX AT THE
TMS STIM SITE IN ORANGE AND THEN
AT ROIs DOWNSTREAM IN THIS
GREY COLOR.
SO WE CAN SEE THAT WHEN
SPECTROSCOPY WAS MEASURED AT
SITES OTHER THAN THE TMS STIM
SITE, WE SEE A SIGNIFICANT
ELEVATION FOR THE GLUTAMATE PLUS
GLS SIGNAL, AND THIS IS TELLING
US THAT THERE IS SIGNIFICANT
INDUCTION OF -- THERE'S A
SIGNIFICANT INDUCTION OF
NEUROEXCITATION AT SITES
DOWNSTREAM OF THE TMS STIM SITE.
SO FUTURE DIRECTIONS.
THERE IS A LOT MORE I WANT TO DO
WITH THE CURRENT DATASET.
FIRST OF ALL I WANT TO
INCORPORATE BEHAVIORAL DATA AND
SEE IF BEHAVIORAL RESPONSES
CORRELATE SYSTEMATICALLY WITH
NEUROMETABOLITE CHANGES.
THERE ARE ALSO A LOT OF
PARAMETERS I WANT TO CONTROL FOR
OR PERFORM ADDITIONAL MODERATOR
ANALYSES ON, LIKE TMS INTENSITY,
NUMBER OF PULSES, SPEC TROS SPEY
SCAN TIME IS ALSO A REALLY
IMPORTANT VARIABLE I WANT TO
TAKE INTO ACCOUNT BECAUSE SOME
OF THESE STUDIES ARE MEASURING
ACUTE EFFECTS AND OTHERS ARE
SUBACUTE OR EVEN CHRONIC.
IN THE LONGER TERM FUTURE
DIRECTION FOR MY THESIS PROJECT,
I'M HOPING TO PERFORM A STUDY
MEASURING THE EFFECTS OF RTMS
USING THREE-DIMENSIONAL IMAGING.
THIS IS GLUTAMATE CHEMICAL
EXCHANGE SATURATE TRANSFER AND
IT HAS SEVEN FOLD SENSITIVITY
COMPARED TO CONVENTIONAL
SPECTROSCOPY.
IT'S ONLY LOOKING AT GLUTAMATE,
THOUGH.
SO WE'RE HOPING TO MEASURE 3D
GUSES BEFORE TMS TO GET A VOLUME
HE TRICK PICTURE OF WHAT'S
HAPPENING TO GLUTAMATE AFTER
THIS CLINICAL PROTOCOL.
AND CEMBER ET AL. PUBLISHED A
PAPER EARLIER THIS YEAR LOOKING
AT GUSES AFTER TMS.
OKAY.
SO I'D LIKE TO THANK MY ADVISORS
AND MY LAB MEMBERS.
I ALSO WANT TO THANK THE ISMRM
FOR PROVIDING SOME FUNDING SO I
COULD HAVE THE OPPORTUNITY TO
TALK TODAY, AND I LOOK FORWARD
TO YOUR QUESTIONS.
[APPLAUSE]
>>YES, GO AHEAD.
>>HELLO?
HI.
I APOLOGIZE IF I MISSED THIS,
BUT IS THIS A MIXTURE OF
DIFFERENT RTMS PROTOCOLS OR JUST
10 HERTZ OR WHAT SPECIFIC RTMS
PROTOCOLS WAS THIS DATA BASED
ON?
>>THAT'S A GOOD QUESTION.
IT'S ALL DIFFERENT RTMS
PROTOCOLS.
MOST OF THEM WERE DONE AT 10
HERTZ BUT THERE WERE A FEW
1 HERTZ AND I THINK A COUPLE
2 OR 5 HERTZ AS WELL.
>>I HAVE A QUESTION HERE.
HOW MUCH OF THIS DATA IS 7 TESLA
AND HOW MUCH IS 3 TESLA?
>>THE DATA I PRESENTED HERE WAS
ALL DONE AT 3T.
I HAVEN'T IDENTIFIED A 7T STUDY
THAT FITS OUR CRITERIA, BUT
THERE ARE A FEW 1.5T THAT I
HAVEN'T INCLUDED YET.
>>I HAVE A QUICK QUESTION.
SO YOU MENTIONED THAT THE GABA
WAS ELEVATED ONLY IN ITMS.
DO YOU THINK THAT'S AN ACTUAL
CONSEQUENCE OF THE DIFFERENCE
BETWEEN MODALITY AND IF SO, I
KNOW YOU HINTED AS IT'S AN OPEN
QUESTION, BUT I'D LOVE TO HEAR
YOU TAKE A STAB AT IT.
>>YEAH.
I PERSONALLY DON'T THINK IT'S A
REAL EFFECT, AND WE DEFINITELY
DON'T HAVE ENOUGH POWER TO SAY
THAT IT IS.
I READ A PAPER DONE IN MICE, I
THINK, THAT FOUND THAT CTBS
PROTOCOLS UPREGULATE GAD, WHICH
IS -- WHICH PRECEDED INCREASE IN
GABA AT THE TMS SITE.
SO I THINK THAT TBS PROBABLY
ALSO UPREGULATES GABA, BUT I
DON'T THINK WE CAN DRAW ANY
CONCLUSIONS FROM THIS DATA.
AND ALSO MY INKLING IS BASED ON
A FEW SCATTERED FINDINGS THAT
I'VE READ ABOUT, SO I'M NOT
REALLY SURE WHAT'S HAPPENING.
>>OKAY, THANK YOU.
[APPLAUSE]
>>OKAY, SO THE NEXT SPEAKER IS
LORAINE FRANKE FROM THE
UNIVERSITY OF MASSACHUSETTS ON
AUGMENTED REALITY VISUALIZATION
OF TMS WITH 3D SLICER AND WEB
XR.
>>THANK YOU FOR THE
INTRODUCTION.
I WORK TOGETHER WITH MY
COLLEAGUES FROM BRIGHAM AND
WOMEN'S HOSPITAL AND HARVARD
MEDICAL SCHOOL, AND OUR PROJECT
IS CALLED AUGMENTED REALITY
VISUALIZATION OF TMS WITH
3DSLICER AND WEBXR.
SO JUST A DECLARATION FOR
FINANCIAL INTEREST.
WE ARE FUNDED BY AN NIH GRANT
THAT WE GOT IN 2021.
SO SOME BACKGROUND, WE HAVE
HEARD A LOT ABOUT IT. MS
ALREABOUT IT. MSALREADY.
IT'S SUPER IMPORTANT TO IMPROVE
THE OVERALL COMPUTATION METHODS
AND NEW NAVIGATION OF SOFTWARE
FOR TMS TREATMENT AND ALSO TO
PLAN TMS TO MAKE IT MORE
EFFECTIVE.
WE BELIEVE TMS CAN BE LEVERAGED
BY AUGMENTED REALITY AND BY
USING FAST REALTIME
VISUALIZATIONS TO IMPROVE
OVERALL USER INTERACTION THAT A
USER CAN BETTER INTERACT WITH
THE ENVIRONMENT AND ALSO IMPROVE
THE TREATMENT OF THE PATIENT.
SO HERE YOU CAN SEE THE PROCESS
HOW OUR WHOLE SOFTWARE MODULE
WILL BE DEVELOPED OR IS
CURRENTLY IN DEVELOPMENT.
WE HAVE AN ELECTRIC FIELD.
IT'S A DEEP NEURAL NETWORK.
WE HAVE ALREADY HEARD SOME TALKS
ABOUT THAT.
YOU CAN FIND THE REFERENCES
BELOW.
SO BASICALLY WHAT WE RECEIVE IS
DATA FROM A NEURAL NETWORK WHICH
IS TRANSFERRED INTO THE NEW
NAVIGATION SOFTWARE SLICER, 3D
SLICER VIA CONNECTION THAT IS
CALLED OPEN IGT LINK.
THEN WE HAVE THE WHOLE
VISUALIZATION MODULE INSIDE 3D
SLICER, AND OUR GOAL IS ALSO TO
BE ABLE TO CONNECT THIS WHOLE
VISUALIZATION TO WEB BROWSER AND
RUNNING THIS WHOLE THING IN VR,
SO THE USER ONLY NEEDS TO START
A BROWSER, AND RUN THE MOBILE
APPLICATION AND SEE HOW HE CAN
TREAT HIS PATIENTS WITH
TESTIMONIES.
MOST OF YOU MIGHT HAVE HEARD OF
3DSLICER.
IT'S AN OPEN SOURCE PLATFORM, IT
HAS A LARGE COMMUNITY, A LOT OF
PEOPLE ARE WORKING WITH IT, ALSO
OTHER PARTS NOT ONLY IN
NEUROMODULATION, SO WE ARE
DEVELOPING EVERYTHING INSIDE
THIS MODULE, INSIDE THE SOFTWARE
AND IT'S BASED ON THE BDK
FRAMEWORK WHICH IS PRETTY FAST
BECAUSE IT'S BASED ON C++ AND WE
CAN ACHIEVE FAST RENDERINGS
INSIDE 3DSLICER.
SO FIRST WE TRANSFER OUR DATA
WHICH WE RECEIVE FROM THE DEEP
LEARNING MODEL INSIDE SLICER SO
WE NEED TO INSTALL A PLUGGER
CALLED OPEN ITT LINK, AND THIS
PLUG-IN WILL TO THE WHOLE
COMMUNICATION WITH THE DEEP
NEURAL NETWORK AND WE CAN DO
SOME NEURAL NETWORK TRANSFER OF
THE NFT FILES WHILE RUNNING
EVERYTHING IN REALTIME SO IT'S
PRETTY FAST, AND WE CAN ALSO
IMPORT THE POSITION, LINEAR
TRANSFORMS AND OTHER DATA WE
RECEIVE FROM OUTSIDE OF THE
PROGRAM.
A CHALLENGE WE HAD TO OVERCOME
IS DEFINITELY THE TRANSFORMS.
SO WE RECEIVED NFT FORMS,
USUALLY IN -- SO IT ALWAYS
DEPENDS AND SLICER IS USUALLY
USING THE RAS COORDINATE SYSTEM
SO WE ALWAYS HAVE TO MAKE SURE
THAT EVERYTHING MATCHES AND ALL
THE MATCHES AND FILES WE
RECEIVE, WE HAVE TO TRANSFORM
THEM INSIDE THE MODULE.
SO HERE YOU CAN SEE THE WHOLE
DEVELOPMENT OF THE SYSTEM.
SO WE HAVE THE NFT FILE THAT IS
COMING INSIDE SLICER AND THEN WE
HAVE THE VECTOR FIELD COMING
FROM THE TMS, AND WE ALSO HAVE
OUR MAGNETIC COIL THAT IS MOVED
ON THE PATIENT'S BRAIN.
AND WE HAVE TO RESAMPLE THEM AND
PUT THEM TOGETHER AND OVERLAY
THEM WITH THE BRAIN MESH.
THE WHOLE THING NEEDS TO BE
ADJUSTED TO SLICER TO THE RAS
SPACE AND THEN WE HAVE THE
OVERLAY ON TO THE BRAIN SURFACE.
AND WE RECEIVE THIS NICE
BEAUTIFUL TEXTURE ON THE BRAIN
SURFACE WHICH WE HAVE ALREADY
SEEN TODAY, AND ON THE RIGHT
SIDE YOU CAN ALSO SEE THAT WE
HAVE THE TMS COIL, WHICH IS THEN
INTERACTIVELY USED BY THE USER
AND MOVED, AND SO IT CHANGES ITS
POSITION AND WE HAVE TO RESEND
THE POSITION BACK TO THE NEURAL
NETWORK.
SO I WILL SHOW YOU A DEMO OF OUR
CURRENT VERSION WE HAVE INSIDE
SLICER.
IT'S A PROTOTYPE SO WE'RE STILL
WORKING ON THAT.
IT'S CURRENTLY SHOWING THE
MAGNETIC FIELD AND YOU CAN SEE
THAT THE USER CAN DRAG AND DROP
EVERYTHING AROUND, HE CAN ADD
HIS OWN NIFTI FILES CURRENTLY,
AND IT'S UPDATING PRETTY FAST,
WHICH WE NEED ALSO FOR THE
VISUALIZATION INSIDE THE FORM.
THE NEXT STEP IS THAT WE NEED TO
TRANSFER THE DATA TO THE FORM.
SO BASICALLY A DOCTOR CAN SEE
THE PATIENT IN PERSON AND CAN
ALREADY TEST THE SOFTWARE JUST
BY USING A MOBILE PHONE.
SO WE'RE USING THE API CALLED
WEBXR, SO BASICALLY WITH WEBXR,
YOU CAN CREATE AUGMENTED REALITY
ENVIRONMENTS INSIDE YOUR PHONE.
WE NEED A SECURE PROTOCOL SO
THIS MEANS WE HAVE A CONNECTION
OPEN ALL THE TIME BETWEEN SLICER
AND OUR BROWSER.
THAT'S A NICE PICTURE OF ME.
SO BASICALLY WHAT WILL HAPPEN IS
THAT THE USER WILL HOLD -- THE
CLINICIAN WILL HOLD THE PHONE ON
HIS PATIENT, AND WE ALSO
INTEGRATED FACE TRACKING WITH
JAVASCRIPT, SO I JUST HOLD THE
PHONE ON THE PATIENT AND I CAN
SEE THE BRAIN IN A FIXED
POSITION AND I CAN MOVE THE
PHONE AROUND AND GET THE
COORDINATES OF THE PHONE WHICH
WILL BE THE COIL IN THE END.
YOU CAN SEE THAT'S A BIT SMALL.
SO SINCE IT'S STILL A PROTOTYPE,
IN THE END WE WILL SEE ON THE
BRAIN PLESH THE MESH THE TMS FIO
THE USER CAN SEE EVERYTHING IN
REALTIME ON THE PHONE.
WE HAVE A FEW CHALLENGES
TRANSFERRING LARGE DATA IN
REALTIME, WE HAD A LOT OF
TESTING GOING ON AND WE HAD TO
GO BACK AND FORTH TO TEST
METHODS TO HAVE LIKE A REALLY
FAST RENDERING OF THE WHOLE
SCENE, THE DIFFERENT COORDINATE
SYSTEMS AND ALSO THAT WEBXR IS
STILL A VERY NEW TECHNOLOGY, SO
FACE TRACKING IS BASICALLY
NON-EXISTENT YET SO WE ONLY USE
JAVASCRIPT, AND YEAH, SO NEXT
STEP WILL BE TO FURTHER INCREASE
THE WHOLE VISUALIZATION PROCESS,
MAKE IT FASTER, IMPROVE THE USER
INTERFACE ON THE PHONE, AND WE
ALSO PLAN FOR PUBLICATION AND
EXPERT STUDY WITH OUR MODULE.
THANK YOU FOR YOUR ATTENTION.
IF YOU'RE INTERESTED, YOU CAN
CHECK OUT GITHUB AND TEST OUR
MODULE, AND WE ALSO BROUGHT A
LAPTOP IF YOU WANT TO SEE IT
LIVE WITH THE NEW NETWORK
BECAUSE THE ONE I SHOWED IS ONLY
THE MAGNETIC FIELD ON THE BRAIN,
SO FEEL FREE TO REACH OUT.
THANK YOU.
[APPLAUSE]
>>THANK YOU.
DO WE HAVE ANY QUESTIONS FROM
THE AUDIENCE?
I HAVE ONE MAYBE TO START.
WHAT'SGOING TO BE THE FIRST
APPLICATIONS OF THIS?
>>SO IT'S BASICALLY -- SO THE
AIM FOR THIS WHOLE THING IS JUST
TO BE ABLE TO TREAT -- TO MAKE
THE TREATMENT PLANNING OF THE
PATIENT TO SEE HOW -- BECAUSE
OTHERWISE WE WILL NEED TO SCAN
THE PATIENT AGAIN AND AGAIN.
AND WITH THAT, WE CAN ALREADY
PLAN THE WHOLE TREATMENT, HOW IT
WILL BE, WE CAN DO SOME
PRECISION TARGETING OF SPECIFIC
BRAIN AREAS, AND ALSO REDUCE
COST OF THE WHOLE TREATMENT.
>>QUICK QUESTION.
SO DOES IT WORK WITH JUST ONE
SPECIFIC TMS COIL OR ARE THERE A
VARIETY OF COILS THAT YOU CAN --
>>SO RIGHT NOW WE HAVE THE TWO
DONUTS, WHICH I JUST ADDED TO
THE SCENE SO THE USER IS FREE TO
ADD ANY OTHER TYPE OF COIL.
SO BASICALLY WE HAVE THE NIFTI
IMAGES FROM THE DONUT COIL, TWO
CIRCLES, BUT IT'S COMPLETELY
FLEXIBLE, SO WE CAN ADD ANY
OTHER TYPE OF COIL AS WELL.
>>COULD THIS ALSO BE EXTENDED
TO VISUALIZE MAYBE AN ADDITIONAL
INFORMATION LIKE TRACTOGRAPHY OR
THESE TYPE OF THINGS?
>>WHAT YOU WANT TO ADD IS MAYBE
SOME FIBER TRACKING THAT WE HAVE
ALSO SHOWING DIRECTIONS OF THE
FIBERS AND ALSO SHOWING THE TMS
MAYBE THE TARGET ON THE FIBERS
LIKE THE TRACTOGRAPHY DATA NEXT
STEPS WE ARE PLANNING.
>>[INAUDIBLE]
>>YES, SO I'M MAINLY FOCUSING
ON THE VISUALIZATION PLOT SO I
HAVE DATA FROM THIS NEW NETWORK
TRAINED ON A SPECIFIC COIL WITH
SPECIFIC IMAGES, BUT IF THE USER
WANTS TO DO THAT, THERE'S NO
RESTRICTION ADDING ANOTHER ONE,
SO IT ALL DEPENDS ON THE NIFTI
FILE WE HAVE.
>>OKAY, THANK YOU.
[APPLAUSE]
OUR NEXT SPEAKER IS HIEU NGUYEN,
HE WILL BE SPEAKING ON ENHANCING
THE EFFICIENCY OF FOCAL TMS
COILS WITH MAG NE TICS COR MAGN.
>>GOOD AFTERNOON.
I'M FIRST YEAR POSTDOC IN THE
NEUROIMAGING RESEARCH BRANCH.
TOPIC I WOULD LIKE TO PRESENT
TODAY, ENHANCING THE EFFICIENCY
OF THE FOCAL TMS COIL WITH
MAGNETIC CORE.
THIS IS AN OUTLINE OF MY TALK,
I'LL GIVE YOU SOME INFORMATION
ABOUT TMS COIL AND THE NEXT ONE
A RECENT DEVELOPMENT -- WE FIND
SOMETHING INTERESTING AND RELATE
TO -- AND MY TALK WITH SOME
CONCLUSIONS AND DISCUSSION.
SO WE KNOW THAT TMS -- BRAIN AND
HUMAN TMS -- 1.5 TESLA, 100 --
STIMULATE THE BRAIN REGION.
THE INDUCTANCE -- CANNOT BE TOO
HIGH OR TOO LOW BECAUSE IF IT IS
TOO HIGH IT WOULD PROVIDE LOW
INTENSITY BUT WHAT IF THE
INDUCTANCE BE L IS L IS TOO LOWE
CORE HEATING.
IN THE TRANSLATION OF TMS COIL
IS 30, TO UNDERSTAND THE
MECHANISM OF TMS CURRENTLY WE
WERE TRYING TO REPLICATE --
HUMAN TMS COIL TO THE -- WE
CANNOT USE THE HUMAN TMS COIL TO
THE RODENT BRAIN BECAUSE THE
BRAIN SIZE.
ABOUT 3 TO 4 SPECIFIC TMS COIL,
BUT WE HAVE LIMITATION THEY ONLY
PASS ON THE -- ON THE FEM MODEL,
AND IF THEY HAVE A STIMULATOR ON
THE COIL THEY CAN ONLY INDUCE A
LOW STIMULATION INTENSITY.
AND THE LAST REASON RELEVANT TO
MY TOPIC TODAY WITH LACK OF
NON-LINEAR STUDY AT THE HIGH
CURRENT, WE WILL HAVE A CORE
SATURATION.
SO WE DEVELOPED A
RODENT-SPECIFIC COIL WITH OUR
2-MILLIMETER FOCAL -- TMS --
ANGLE SO DIFFERENT INDUCTANCE SO
WE USE THE SER METER TO MEASURE
THE INDUCTANCE AND ALSO WE USE
METER TO MEASURE -- HIGH
INDUCTANCE COIL NUMBER 4 WE ALSO
SAW THE HIGH -- SO IN ORDER TO
DRIVE THIS WE DEVELOP OUR --
DELIVER MAXIMUM -- UP TO
6,000 -- IN THE PICTURE YOU CAN
SEE WE PUT DRY ICE AROUND THE
COIL.
WE CAN PUT IT RIGHT AROUND -- ON
TOP OF A COIL IF WE RUN THE HIGH
FREQUENCY TMS.
IN ORDER TO TEST THE EFFICIENCY
OF THE COIL, WE PASS IT UNDER
A -- WE TARGET THE -- BEFORE.
TO MOVE THE -- OF THE COIL TO
THE CORRECT MOTOR CORTEX WE NEED
IMPLEMENTATION WITH THE OFFSET
AND THICKNESS OF THE COIL GUIDE.
LATER WHEN WE TRY TO INSERT A
RELIABLE MEASURE THE SIGNAL
WE -- OF THE EMG -- ON THE
HINDLIMB MUSCLE.
AND BASED ON THE RESULT WE --
ANALYSIS, WE -- THE COIL
NUMBER -- MORE EFFICIENT MOTOR
THRESHOLD BUT THIS ONE WAS ALSO
A LITTLE BIT BECAUSE IT AGAIN IS
THE RELATION BETWEEN THE -- AND
INDUCTANCE -- SO WE ADOPT
LITERATURE -- TMS SO THE LOOKED
LIKE IF WE TRY TO --
INDUCTANCE -- FIELD TO THE
BRAIN.
AND IF WE HAVE -- POSITIVE AND
THE NEGATIVE -- WE GET MOST OF
THE PARAMETER IN THE EQUATION
AND WE ONLY CHANGE THE
INDUCTANCE -- MEASUREMENT.
SO FOR THE SIMULATION WE SAW --
WE CAN SEE THAT THE HIGH
INDUCTANCE COIL ACTUALLY HAS A
LONGER -- BUT ALLOW LOW
INDUCTANCE COIL ACTUALLY PROVIDE
STRONGER CURRENT AND STRONGER
E-FIELD AT VERY BEGINNING, BUT
IN GENERAL, WHEN WE COMPUTE THE
AREA ON THE CURVE, WE ACTUALLY
SEE THAT HIGH INDUCTANCE -- COIL
NUMBER 4 ACTUALLY HAVE A HIGHER
AREA IN THE CURVE COMPARED TO
LOW INDUCTANCE COIL.
SO -- BY THE CURVE AND FOR THIS
SLIDE WE -- GROUP.
AND WE TRY TO MODEL THE REAL
CORE THAT'S WHY WE PUT SOME OF
THE REAL PARAMETER -- SO --
100 100LITZ WIRES -- THE TMS
APPLICATION SO THAT CAN SHOW YOU
THAT THE INDUCTANCE WITH SOME
SMALL ERROR.
AT THE HIGH CURRENT OR HIGH --
FIELD, IT WOULD REDUCE THE LOW
AVERAGE PRP -- INDUCTANCE, SO ON
THE TABLE BELOW YOU CAN SEE THAT
1,000 -- THE INDUCTANCE -- IS
ALREADY REDUCED TO SIGNIFICANT
NUMBERS.
HOWEVER, WHEN WE TEST THE --
FIELD AT 1 CENTIMETER BELOW
THE -- THE CAN SHOW YOU THAT THE
FIELD OF THE HIGH INDUCTANCE
COIL ACTUALLY A LITTLE BIT
HIGHER COMPARED TO LOW
INDUCTANCE COIL.
SO IN CONCLUSION, WE HAVE
DEVELOPED A NUMBER OF -- WITH
MAGNETIC CORE AND THEN WE USE
LINEAR AND NON-LINEAR -- TO --
TMS -- IT CAN ALSO EXPLAIN A
LITTLE BIT BY -- THE EXPERIMENT
WE -- WE SAW LONGER PULSE WIDTH
AND WITH THE LONGER PULSE WE CAN
REDUCE -- FABRICATED --
TIME-CONSUMING SO -- CAN WE FIND
THE OPTIMAL PARAMETER BETWEEN
THE INDUCTANCE -- B, THERE WOULD
BE A TRADEOFF BETWEEN THE B, L
AND E IN TERM OF COIL EFFICIENCY
AND ALSO IN THE EXPERIMENT WE
ALSO -- THE HIGH INDUCTANCE CORE
ACTUALLY CAN AFFECT -- HARDWARE
IF WE'D RUN THE HIGH FREQUENCY
TMS SUCH AS RTMS OR RTBS --.
SO THANK YOU FOR YOUR ATTENTION.
I WOULD LIKE TO THANK YOUR
SUPPORT FROM OUR INVESTIGATOR
AND COLLABORATORS.
[APPLAUSE]
>>IS THERE ANY QUESTION?
>>I HAVE ONE.
DID YOU ALSO CHARACTERIZE THE
FOCALLITY OF THE COIL?
>>YES, LIKE I THINK FOUR YEARS
AGO, THE FOCALLITY IS AROUND
2-MILLIMETER.
SO PREVIOUSLY WE USE A CORE
GUIDE WITH THE OFFSETS AND EVERY
TIME WE MOVE THE LEFT RIGHT --
EVERY TIME 1-MILLIMETER TO SEE
WHICH ONE WOULD PRODUCE A BIG
MEP.
AND ALSO WE CAN ALSO USE THE --
WE THOUGHT WE USE REVERSE -- TO
MEASURE WHAT IS THE HOT SPOTS OF
THE COIL AND WITH THAT HOT SPOT
WE CAN USE A COIL GUIDE TO MAP
IT.
>>ARE THERE ANY OTHER
QUESTIONS?
IF NOT, THANK THE SPEAKER AGAIN.
[APPLAUSE]
THE NEXT SPEAKER IS CHARLOTTE
KIONG LI FROM THE NATIONAL
INSTITUTE ON DRUG ABUSE IN
BALTIMORE ON HIGH-DENSITY THETA
BURST PARADIGM AUGUSTMENTS THE
AFTER EFFECT OF TRANS CRANIAL
MAGNETIC STIMULATION IN RODENTS.
>>HELLO, EVERYONE GOOD
AFTERNOON.
TODAY I'M GOING TO TALK ABOUT
THE HIGH-DENSITY THETA BURST
PARADIGM AND THE AFTER EFFECTS
OF TMS.
TODAY IN THIS TALK, I'M GOING TO
INTRODUCE THE MOTIVATION THAT
YOU INCREASE THE THERAPEUTIC
EFFICIENT IN TMS.
CURRENTLY TMS IS NOW USED IN
TREATMENT OF THE DEPRESSION,
DEPRESSION DISEASE, AND
CURRENTLY IT CAN ONLY INTRODUCE
A MODEST EFFECT.
SO WE ARE AIMING TO INTRODUCE A
NEW PARADIGM THAT SHOWING THE
HIGH FREQUENCY AND HIGH
THERAPEUTIC EFFICIENCY.
SO IN THIS TALK I'M GOING TO
EXPLAIN IN THREE ASPECTS.
THE FIRST IS HOW THIS IDEA COMES
AND SECOND IS HOW WE OPTIMIZE
THE SYSTEM AND THEN AFTER
EFFECTS OF THIS NEW PARADIGM.
EARLY IN 1986, THE STIMULATION
ON THE HIPPOCAMPUS SLICE IN
DIFFERENT FREQUENCY, AND HE
FOUND DIFFERENT FREQUENCY WILL
RESULT IN DIFFERENT AFTER
EFFECTS.
THEY FOUND .2 SECONDS BETWEEN
EACH PULSE.
THE AFTER EFFECTS CAN ACHIEVE
THE HIGHEST.
HOWEVER, WHEN THE INTERVAL IS
2 SECONDS, THE AFTER EFFECTS IS
THE LOWEST.
.2 SECONDS INTERVAL STAYS AT
5 HERTZ FREQUENCY WHICH IS --
SERTA ACTIVITY.
LATER ON IN 2005, THERE IS A
BREAKTHROUGH DEVELOPMENT IN THE
TMS PARADIGM.
KWAN'S GROUP HAS FOUND THAT TMS
APPLIED IN 20 CYCLE OF 2 SECONDS
ON 2 SECONDS OFF PATTERN AND
WITH TAM BURSTS -- 5 HERTZ CAN
ACHIEVE THE SAME EFFECTS AS THE
CONVENTIONAL 10 HURTS -- TMS.
HOWEVER IT IS IN A MUCH HIGHER
TIME EFFICIENCY.
SO THIS MEANS THE THETA BURST
STIMULATION IS OPTIMIZED
FREQUENCY THAT CAN INDUCE THE
HIGH THERAPEUTIC EFFICIENCY.
HOW TO INCREASE THE THERAPEUTIC
EFFICIENCY FURTHER, COLE IN 2020
STATES THAT THE FDA MIGHT ONLY
APPROVE THE PARADIGM THAT
SHOWS -- THAT SHOWS HIGH SAFETY
RANGE, SHOWS HIGH SAFETY THAT IN
THE LOW END, OR THE MIDDLE RANGE
OF THE SAFETY.
SO WE CAN INCREASE THE DOSE OF
THE STIMULATION.
SO COLE'S GROUP DEVELOPED
PARADIGM WHICH -- THEY FIRST
INCREASE THE ITBS SESSION, AND
THEN THEY DO 10 SESSIONS PER DAY
FOR CONTINUOUS FIVE DAYS.
AND THIS PARADIGM HAVE ACHIEVED
VERY HIGH RESPONSE RATE THAT WAS
OVER90.48.
HOWEVER, FOR THE BIG SHAM EFFECT
IN THE TMS STUDY, THIS STUDY
HAVE DONE NO SHAM CONTROL, WHICH
MEANS -- WHICH PUT A LARGE
QUESTION MARK ON THIS STUDY.
HOWEVER, WE CANNOT THINK
INCREASE THE DOSE CAN DIRECTLY
RESULT IN THE INCREASE AFTER
EFFECTS.
IN 2010, A GERMAN GROUP HAVE
DOUBLED THE DOSE OF THE ITBS AND
THEN FOUND WHY ITBS ITSELF WILL
HAVE ECK EYE TAITION EFFECT ON
THE CORTEX DOUBLE THE EFFECTS
WILL HAVE INHIBITORY EFFECTS ON
THE CORTEX LEVEL.
AND THEN THEY DOUBLED THE --
DOUBLED ANOTHER PARADIGM CALLED
CONTINUOUS TBS WHICH WOULD
RESULT IN THE INCUBATION EFFECT
ON THE CORTEX, HOWEVER, WHEN
DOUBLED IT RESULTED IN AN
EXCITATORY EFFECT ON THE CORTEX.
THIS STUDY SHOWS THAT INCREASE
THE DOSE OF STIMULATION IS --
HAVE A VERY COMPLEX MECHANISM
UNDERLYING IT, AND OUR
PURPOSE -- TIME EFFICIENCY WHILE
INCREASING THERAPEUTIC VALUE SO
WE RAISE OUR IDEA THAT INCREASE
THE NUMBER OF PULSES IN EACH
BURST.
THAT IS THE HIGH-DENSITY
STIMULATION.
NOW WE HAVE THE IDEA WE NEED TO
OPTIMIZE THE SYSTEM TO -- IN
ORDER TO COMPLEMENT THE IDEA.
SO MY COLLEAGUE HAVE DEVELOPED A
STIMULATOR WHICH HAS HIGH POWER
UNIT ON THE PCB.
THIS COMPONENT ENABLE TO SEND
THE 4.5 KILOVOLT IN A VERY
STABLE MANNER.
HERE IS PROCESS 200 MILLISECONDS
AND WE CAN SE SEE THE FIRST PULE
HAVE THE MAGNITUDE OF THE
CURRENT FOR 3 KILLIAMP, 9.42KA
AND THE DIFFERENCE IS ONLY 4%
WHICH SUGGESTS VERY HIGH
STABILITY OF THE -- VERY HIGH
STABILITY OF THE STIMULATOR.
ALSO FOR THE HUMAN STUDY, WE
ALWAYS MEASURE THE MEP
RECORDING.
WE ALWAYS MEASURE THE MEP TO USE
AT THE OUTPUT OF THE -- AT THE
STIMULATION.
HOWEVER, IN ANIMALS, THE MEP
RECORDING IS NOT ALWAYS
STRAIGHTFORWARD.
WE HAVE TRIED DIFFERENT METHODS,
AND LATER WE FOUND THAT TO PUT
TWO ELECTRODES IN DIFFERENT
MUSCLE GROUPS IN THE RAT HIN
HINDLIMB CAN CAUSE VERY STABLE
RESULTS AND WE CONNECTED THAT --
TO THE COMPUTER.
HERE IS THE RESULT SHOWS
CONSISTENCY OF THE MEP
MEASUREMENT.
WE HAVE FIVE RATS AND MEP SIGNAL
MEASURED IN DAY ONE AND DAY SIX.
WE CAN FIND THE PATTERN OF THE
MEP SIGNAL ARE VERY SIMILAR TO
EACH OTHER IN THE MAGNITUDE AND
THE PATTERN SHAPE.
AFTER WE ACHIEVE THE SYSTEM AND
OUTPUT, AFTER WE OPTIMIZE THE
SYSTEM AND OUTPUT, HERE WE
RECORDED THE -- HERE WE RECORDED
THE MEP SIGNAL AFTER THE FIVE
MINUTES, 10 MINUTES, 15 MINUTES,
20 MINUTES, AND UP TO 35 MINUTES
AFTER THE APPLICATION OF THE
ITBS.
SO OUR PARADIGM, THE DIFFERENCE
BETWEEN OUR PARADIGM WITH THE
CONVENTIONAL THETA BURST
PARADIGM IS WE INCREASE THE
NUMBER OF PROCESS IN THE BURSTS,
IN A SINGLE BURST.
SO IN KWAN'S PARADIGM, WE ONLY
HAVE THREE PROCESS.
HOWEVER, WE TRIED FOUR
CONDITIONS.
THAT IS THREE, FOUR, FIVE, SIX
PULSES IN A SINGLE BURST.
WE HAVE TESTED IT ON 15 RATS AND
IT'S VERY EXCITING TO NOTICE
THAT NO SEIZURE INDUCED.
HERE IS OUR RESULTS.
SO THE LEFT PANEL SHOWS THE RAW
DATA HISTOGRAM.
WE CAN SEW THE RAW DATA ACTUALLY
SHOWS NOT NORMALLY DISTRIBUTED.
THUS WE CANNOT USE THE
PARAMETRIC METHOD TO TEST THE
DIFFERENCE.
SO WE FIRST USED THE BOX --
TRANSFORMATION TO TRANSFER THE
NON-DISTRIBUTED RAW DATA TO
NORMALIZE THE RAW DATA.
AND THEN LATER ON, WE USE THE
TWO WAY REPEAT MEASURE INOVA THE
PARAMETRIC METHOD TO TEST TIME
AND PULSE TYPE INTERACTION, AND
WE FOUND THE TIME IS -- HAVE
SIGNIFICANT RESULTS IN THE MEP
SIGNAL, AND THE PULSE TYPE ALSO
HAVE SIGNIFICANT EFFECT ON THE
MEP SIGNAL.
HOWEVER, THERE IS NO EFFECT
BETWEEN TIME AND INTERACTION
WITH THE PULSE TYPE.
WE FURTHER ANALYZE THE MEP
ACROSS TIME, NORMALIZE TO THE
BASELINE.
SO WE REGARD THE BASELINE TO ONE
AND THEN WE DRAW THE LINE CHECK
UNDER FOUR DIFFERENT CONDITION,
AND THE BLUE LINE IS THE PULSE
AND ORANGE LINE IS 4 PULSE AND
GREEN LINE IS 5 PULSE AND
THERE'S LIKE RED LINE 6 PULSE.
AND WE CAN FIND THE 6 PULSE HAVE
A VERY SIGNIFICANT HIGHER EFFECT
HOWEVER THE FOURTH AND FIFTH
LINE DIDN'T SHOW A VERY OBVIOUS
PATTERN SO WE NEXT DRAW ANOTHER
RESULTS USING -- UNDER THE CURVE
OF EACH CONDITION.
AND COMPARE THEM USING THE
NON-PARAMETRIC TEST.
WE FOUND THE RESULTS IS VERY
SIGNIFICANT.
THE 5 PULSE INCREASE THE --
INCREASE AFTER EFFECTS FOR 57%
AND THE 6 PULSE EVEN HIGHER
INCREASED THE -- INCREASED THE
AFTER EFFECTS FOR 92% COMPARED
TO THE -- COMPARED TO THE
CONVENTIONAL 3 PULSE -- 3 PULSE.
AND THIS PART -- AND NOW THE
RESULT SHOWS THAT THE
HIGH-DENSITIES THAT HAVE
REVERSED PARADIGM CAN RESULT
IN -- CAN HAVE THE HIGH
THERAPEUTIC -- MAY HAVE HIGH
THERAPEUTIC VALUE AND ALSO IT
SHOWS A VERY HIGH TIME
EFFICIENCY.
NOW IT'S TIME AND HERE'S THE
TAKEHOME MESSAGE.
SO IN THIS STUDY WE PROPOSED AND
IMPLEMENTED A HIGH-DENSITY THETA
BURST PAIR TIME AND THIS
HIGH-DENSITY THETA BURST
PARADIGM WAS SUCCESSFULLY -- RAT
AND NO SEIZURE INDUCED.
WE FOUND THERE'S ENHANCED AFTER
EFFECTS COMPARED WITH
CONVENTIONAL THETA BURST.
I WOULD WANT TO SHOW GREAT
THANKS TO MY SUPERVISOR, DR. LIU
AND -- FOR THEIR GENEROUS
SUPPORT ON EVERYTHING.
AND I ALSO WANT TO THANK TO MY
LAB MATES AND COLLABORATORS.
FOR
THEIR HELP AND SUPPORT.
THANK YOU SO MUCH.
[APPLAUSE]
>>THANK YOU.
DO WE HAVE ANY QUESTIONS FROM
THE AUDIENCE?
I HAVE ONE WHICH IS, NOW THAT
YOU'VE SEEN THAT 6 PULSE WORKED
BETTER, DO YOU INTEND TO GO EVEN
BEYOND THAT?
WHERE DO WE STOP?
>>I THINK WE HAVEN'T TESTED THE
PROCESS BEYOND THAT.
MAYBE THE SYSTEM HAS THE
LIMITATION.
BUT I'M NOT WORKING ON THE
SYSTEM, SO MAYBE WE CAN DISCUSS
WITH COLLABORATOR AFTER THAT.
>>AND DOES IT HAVE AN IMPACT ON
THE COIL HEATING?
>>WE DON'T HAVE ANY LIMIT ON
THE COIL HEATING, WE'RE NORMALLY
USING DRY ICE, AND IT CAN REDUCE
THE HEAT OF THE COIL AND IT'S
SAFELY SURVIVED DURING THE WHOLE
EXPERIMENT.
ANY OTHER QUESTIONS?
>>OKAY, WE'RE RUNNING A LITTLE
BIT BEHIND TIME, SO IF WE CAN
THANK THE SPEAKER ONCE MORE.
[APPLAUSE]
OUR LAST SPEAKER TODAY IS NOREEN
BUKHARI-PARLAKTURK, ENTITLED
TASK FMRI IDENTIFIES
STATE-DEPENDENT CHANGES IN
BRAINNET WORKS IN WC DYSTONIA:
IMPLICATIONS FOR TRANSCRANIAL
MAGNETIC STIMULATION TARGETING.
>>I GUESS THIS IS THE LAST
TALK, SO THANKS FOR STAYING AND
MAYBE STAYING AWAKE.
I'M NOT NOREEN.
NOREEN IS ACTUALLY IN THE
AUDIENCE.
SHE'S THE P.I. OF THE PROFNLG.
PROJECT.
I'M ANDREW MICHAEL AND I'M
PRESENTING ON BEHALF OF NOREEN.
SO THIS PROJECT IS ACTUALLY A
LARGE PROJECT THAT HAS TMS AT
DIFFERENT TIME POINTS, AND ALSO
MULTIPLE FMRI ACQUISITIONS.
TODAY'S RESULTS ARE BASED ONLY
ON THE BASELINE FMRI, SO THERE'S
NO STIMULATION IN THE WHOLE
STUDY ON THIS FINDING.
SO WHAT WE'RE TRYING TO DO HERE
IS BASICALLY SEE IF WE CAN APPLY
A DATA-DRIVEN MECHANISM TO
IDENTIFY ALTERED BRAINNET WORKS
IN DYSTONIA.
SO A LITTLE BIT OF BACKGROUND
ABOUT WRITER'S CRAMP DYSTONIA.
AS YOU CAN SEE IN THE PICTURE,
THE PATIENTS WHO HAVE WRITER'S
CRAMP DYSTONIA, THEY BASICALLY
CRAMP UP WHEN THEY WANT TO
WRITE.
DYSTONIA GENERALLY IS A
DISABLING BRAIN DISORDER OF
NORMAL AND PAINFUL POSTURES,
SYMPTOMS OF DYSTONIA.
IT MANIFESTS IN TWO DIFFERENT
FORMS, THE GENERALIZED VERSUS
THE FOCAL.
THE GENERALIZED MANIFESTS OVER
THE WHOLE BODY, THE FOCAL IS
ISOLATED TO A SINGLE LIMB.
DYSTONIA, THE NEUROIMAGING
STUDIES HAVE SHOWN THE DYSTONIA
IS A DISORDER OF BRAINNET WORK
DISRUPTIONS.
SO IF YOU LOOK AT PREVIOUS TASK
FMRI STUDIES IN DYSTONIA,
THEY'RE PRIMARILY
HYPOTHESIS-DRIVEN, MEANING THEY
ARE LIMITED TO REGIONS OF
INTEREST, AND TYPICALLY APPLY
LINEAR MODELING APPROACHES.
IN ADDITION, THEY ALSO ASSUME
THE EXACT SAME HEMODYNAMIC
RESPONSE FUNCTION ACROSS ALL
SUBJECTS, TASKS AND BRAIN
REGIONS.
AND THIS IS A HUGE ASSUMPTION
BECAUSE THERE COULD BE CHANGES
IN THE HEMODYNAMIC RESPONSE
FUNCTION.
ALSO WITH THAT APPROACH, IT'S
DIFFICULT TO CAPTURE ACCURATELY
THE ACTIVATION DELAYS AND
PATTERNS OF ACTIVATIONS THROUGH
THE TYPICAL CONVENTIONAL
HYPOTHESIS-DRIVEN APPROACH.
SO IN THIS STUDY, WHAT WE'RE
DOING IS WE'RE USING A
DATA-DRIVEN METHOD TO IDENTIFY
FUNCTIONAL NETWORKS.
SO WE'RE USING INDEPENDENT
COMPONENT ANALYSIS OR ICA.
THEY DO NOT REQUIRE A PRIORI
ROIs, AND MAKE NO ASSUMPTIONS
ABOUT THE HRF.
SO IN THE PICTURE, SOME OF THE
NETWORKS FROM A PREVIOUS STUDY,
YOU CAN SEE YOU CAN IDENTIFY
SPATIALLY DISTRIBUTED NETWORKS
THAT HAVE TEMPORAL COHERENCE.
SO THIS PARTICULAR STUDY HAVE 12
DYSTONIA PARTICIPANTS.
ALL HAD RIGHT HAND DOMINANT
DYSTONIA.
DIAGNOSIS WAS MADE BY A MOVEMENT
DISORDER SPECIALIST, AND WE ALSO
HAD 12 AGE MATCHED HEALTHY
CONTROLS, AND THEY WERE ALSO
RIGHT HAND DOMINANT.
AND THE CONTROLS DID NOT HAVE
ANY BRAIN OR PSYCHIATRIC
DISORDERS.
MORE DEMOGRAPHICS ON SUBJECTS.
AS I SAID, 12 IN EACH GROUP.
THE AGE WAS AROUND 54 YEARS.
THE DYSTONIA PATIENTS HAD THE
WRITER'S CRAMP DYSTONIA,
DURATION WAS ABOUT 9 1/2 YEARS.
IN THE FMRI PARADIGM, WE HAD
THREE DIFFERENT TASKS, WRITING,
TAPPING AND EXTEND.
THERE WAS NO MOTION DIFFERENCES
BETWEEN THE TWO GROUPS.
HOWEVER, AS YOU WOULD EXPECT,
THERE WERE BEHAVIORAL MEASURES
THAT WERE SIGNIFICANTLY
DIFFERENT BETWEEN THE TWO
GROUPS.
SO THESE ARE THOSE BEHAVIORAL
MEASURES.
SO THREE DIFFERENT TASKS WE USED
WERE WRITING, TAPPING AND
EXTEND.
THE TAPPING AND EXTEND TASKS
WERE USED TO SERVE AS CONTROLS,
BASICALLY NON-DYSTONIC CONTROL
TASK.
IT WAS EXTREMELY SIM PEM, IT WAS
AN ON OFF BLOCK DESIGN, 20
MINUTES OF TASK, 16 SECONDS OF
REST.
AND THE TOTAL TASK DURATION WAS
ABOUT 7 1/2 MINUTES.
SO WE GAVE THE FMRI, THE TASK
FMRI DATA, FED IT INTO THE
ALGORITHM ACROSS ALL THREE
TASKS, AND ALSO THE TWO GROUPS.
WHEN WE REMOVED THE NOISY
COMPONENTS AND ALSO THE
PHYSIOLOGICAL COMPONENTS, AND
ALSO WHEN WE LOOKED AT WHICH
COMPONENTS WERE -- OR WHICH
NETWORKS WERE TASK HA-RELEVANT,E
ENDED UP WITH THESE EIGHT
NETWORKS, AND THEY ARE THE
SENSORY MOTOR NETWORK LEFT, THE
PARTICIPANTS WERE USING THEIR
RIGHT HAND TO PERFORM THE TASK,
THE LEFT NETWORK SHOWED UP AS
PERMANENT.
THE LEFT NETWORK VISION NETWORK,
THE CEREBELLUM, BASAL GANGLION,
RIGHT, FRONTAL CORTEX AND DMN.
SO WE WERE LOOKING AT THESE
EIGHT NETWORKS IN PARTICULAR.
SO THE FIRST ANALYSIS WE DID WAS
WE ASKED THE QUESTION, HOW DO
THESE NETWORKS CORRELATE WITH
TASK PRESENTATION, RIGHT?
HOW RELEVANTLY ARE THEY
ACTIVATING ACCORDING TO THE
TASK?
SO THIS IS THE CORRELATION, AND
AS YOU WOULD EXPECT, BOTH -- I
SHOULDN'T SAY BOTH BUT A VERY
HIGH CORRELATION IN THE SENSORY
MOTOR NETWORK LEFT, BUT THE
PATIENTS ALSO HAD A VERY HIGH
CORRELATION IN THIS PARTICULAR
NETWORK.
WHAT WAS INTERESTING WAS, IN
SOME NETWORKS, FOR EXAMPLE, THE
CEREBELLUM, THEY BOTH SHOW A
POSITIVE CORRELATION BUT THE
PATIENTS HAD A HIGHER VARIANCE.
NOW, WHEN IT COMES TO THE BASAL
GANGLION, THE CONTROLS HAD
AVERAGE POSITIVE CORRELATION,
BUT THE PATIENT HAD AN AVERAGE
NEGATIVE CORRELATION.
YOU ALSO SEE SIGNIFICANT
DIFFERENCES IN THE ORBITAL
FRONTAL CORTEX, AND AS YOU WOULD
EXPECT, WE ALSO SEE A HIGH
NEGATIVE CORRELATION IN THE
DEFAULT MODE NETWORK.
THEN WE ASKED, OKAY, IS THERE
ANY DIFFERENCE IN TERMS OF THE
ACTIVATION PATTERN OF THE
NETWORK.
SO WE AVERAGED ALL THESE
ACTIVATIONS INTO AN AVERAGE
BLOCK, MEANING EACH BLOCK WAS
AVERAGED OVER AGAIN AND ALSO
ACROSS SUBJECTS.
WHAT WE SEE IS THAT IN THE
SENSORY MOTOR NETWORK LEFT,
THERE ISN'T ANY SIGNIFICANT
DIFFERENCE BETWEEN THE TWO
GROUPS.
WHEREAS IN THE BASAL GANGLIA,
THERE ARE SIGNIFICANT
DIFFERENCES.
THE PATIENTS ARE A LITTLE
DELAYED IN RAMPING THE NETWORK
AND ALSO THERE IS AN OVERSHOOT
AND THEY DON'T COME BACK TO THE
BASELINE AS QUICKLY AS THE
CONTROLS.
I'M NOT SURE WHAT'S GOING ON
THERE.
SO BASICALLY WHEN WE LOOKED AT
THE FUNCTIONAL NETWORK
CONNECTIVITY MEANING HOW ARE
THESE NETWORKS TALKING TO EACH
OTHER, WHAT WE SAW WAS THAT THE
SENSORY MOTOR LEFT NETWORK AND
THE BASAL GANGLIA WERE TALKING
IN A POSITIVE WAY IN CONTROLS,
BUT THEY WERE NEGATIVELY
CORRELATED IN PATIENTS, AND THAT
RESULT WAS SIGNIFICANTLY
DIFFERENT.
THERE WERE ALSO SOME OTHER
NETWORKS, THE PARIETAL AND THE
OFC.
THE WAY THEY WERE COMMUNICATING
TO OTHER NETWORKS WERE ALSO
SIGNIFICANTLY DIFFERENT.
SO IN CONCLUSION, WE BASICALLY
SAW THAT THE FUNCTIONAL
CONNECTIVITY BETWEEN THE SENSORY
NETWORK AND BASAL GANGLIA IS
ALTERED IN WRITER'S CRAMP
DYSTONIA.
WE ALSO UNCOVERED THE ORBITAL
FRONTAL AND SUPRAPARIETAL
NETWORKS TO BE ALTERED AND WE
DID THE ANALYSIS IN A
DATA-DRIVEN MANNER, AND I DID
NOT PRESENT THESE RESULTS
BECAUSE OF THE TIME CONSTRAINT,
BUT THESE DIFFERENCES WERE NOT
SEEN DURING THE TAPPING OR THE
EXTENSION TASKS.
SO WE SAW THESE ONLY IN THE
WRITING TASK.
FINDINGS NEED TO BE REPLICATED
WITH THE LARGER SAMPLE SIZE.
WE HAVE 24 SUBJECTS IN OUR STUDY
SO FAR.
I MEAN NOT SO FAR BUT I THINK WE
HAVE ABOUT 50 SUBJECTS NOW.
AND THEN THROUGH A DATA-DRIVEN
ICA APPROACH, WE ALSO SHOWED
THAT WE CAN IDENTIFY
TASK-RELEVANT NETWORKS, AND THIS
PROCESS CAN BASICALLY UNCOVER
NOVEL NETWORKS, YOU KNOW, THAT
MAY BE ALTERED IN DIFFERENT
DISEASES.
SO THIS GENERAL APPROACH CAN BE
USEFUL TO INFORM NEUROMODULATION
TARGETING, BECAUSE YOU'RE NOT
MAKING ANY ASSUMPTIONS ON THE
DEEP NETWORKS THAT MAY BE
INFLUENCING.
AND THEN YOU CAN ALSO EVALUATE
HOW THESE NETWORKS ARE CHANGING
WITH TMS.
SO THAT'S ABOUT IT.
ACKNOWLEDGMENTS, WE WOULD LIKE
TO THANK ALL THE PARTICIPANTS,
AND THEN NOREEN'S LAB MEMBERS
AND COLLABORATORS, AND ALL THE
DIFFERENT FUNDING AGENCIES.
THIS IS MY EMAIL IF YOU HAVE ANY
QUESTIONS ABOUT THIS METHOD OR
HOW TO APPLY IT.
I'M HAPPY TO HELP.
WITH THAT, I CONCLUDE.
[APPLAUSE]
>>ARE THERE ANY QUESTIONS FROM
THE AUDIENCE?
>>I HAVE SOME.
SO WITH THIS TYPE OF PARADIGM,
BLOCK DESIGN, IT VERY EASY TO
HAVE SOME CONTRIBUTIONS FROM --
OR RESPIRATORY CYCLE, IF YOU
SOMEHOW ARE LUCKY AND THEN WITH
THE FREQUENCY IT FALLS BACK INTO
YOUR DATA.
DID YOU MEASURE FOR THESE
CONFOUNDS TO CORRECT FOR IT?
>>YES, SO YOU COULD -- THE
RESPIRATION AND CARDIAC CYCLES
FROM THE DATA BEFORE YOU FEED
INTO THE ICA ALGORITHM.
BUT IN ADDITION, WHEN YOU DO
ICA -- THE ALGORITHM ALSO FINDS
THE NETWORKS THAT CORRESPOND TO
RESPIRATION AND BLOOD FLOW.
SO THAT IS ANOTHER ADVANTAGE OF
USING ICAs, THAT YOU CAN KIND
OF SEPARATE OUT THE
CONTRIBUTIONS OF THOSE THROUGH
THE ICA PROCESS.
BECAUSE TEMPORAL PATTERNS ARE
DIFFERENT IN THOSE NETWORKS.
>>AND MY SECOND QUESTION WAS,
DID YOU TRY TO APPLY
CONVENTIONAL TASK FMRA ANALYSIS
DAY TO REPRODUCE WHAT WAS
ALREADY IN THE LITERATURE?
>>SO THE USUAL SENSORY MOTOR
REGIONS DIDN'T LIGHT UP, BUT
WITH THAT APPROACH, YOU CANNOT
DO KIND OF A NETWORK-LEVEL
ANALYSIS, SO WE WANTED TO
INVESTIGATE WHAT DOES THE DATA
TELL.
SO THAT'S WHY WE USED THE IC
APPROACH.
TYPICALLY IC IS APPLIED TO
RESTING STATE FMRI, VERY OFTEN,
BUT YOU CAN ALSO EASILY APPLY TO
TASK FMRI AND GET VERY GOOD
RESULTS.
>>ARE THERE ANY OTHER QUESTIONS
FROM THE AUDIENCE?
>>ONE LAST QUESTION.
SO YOU MENTIONED THAT THERE ARE
IMPLICATIONS FOR HOW TO BEST
INFORM NEUROSTIMULATION.
WHAT WOULD YOU SUGGEST IN BASAL
GANGLIA NETWORKS OR WHAT TO
TARGET FOR NEXT STEPS?
>>I GUESS YOU CAN UNCOVER IN
THESE TASK FMRI PARADIGMS WHAT
ADDITIONAL NETWORKS MAY BE
CORRELATED THAT YOU MIGHT MISS
IN THE USUAL CONVENTIONAL TASK
FMRI ANALYSIS, BUT THE
APPLICATION OF TMS COMES INTO
PLAY NOT IN TERMS OF IDENTIFYING
THE TARGET LOCATIONS, BUT IN
EVALUATING HOW THESE DEEP
NETWORKS MAY BE CHANGING AFTER
TMS, AND YOU KNOW, IF YOU HAVE
TWO GROUPS, THEN YOU CAN EASILY
CHECK WHETHER THE DISEASE GROUP
IS COMING CLOAER CLOSER TO THE L
GROUP.
SO IN THAT WAY, IT IS
INFORMATIVE.
COSDOES THAT MAKE SENSE?
>>ABSOLUTELY.
SO IT'S MORE LIKE A MARKER OF AN
INTERVENTION.
>>BY CHANGING JUST, FOR
EXAMPLE, THE BASAL BEGAN GLIAL
A, THAT'S KNOWN TO BE
DYSFUNCTIONAL IN DYSTONIA, BUT
IN ADDITION TO THAT, IS TMS
AFFECTING OTHER HIDDEN NETWORKS
THAT WERE PREVIOUSLY NOT KNOWN.
>>THANK YOU.
ANY OTHER QUESTIONS?
ALL RIGHT.
LET'S THANK OUR SPEAKER ONE LAST
TIME.
[APPLAUSE]
THAT CONCLUDES OUR SESSION