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Solutions 2012: Health Care

It Is Brain Surgery

From research into some of the world's leading causes of death (heart disease, diabetes, cancer) to finding solutions for Parkinson's disease, malaria and traumatic injury, Vanderbilt engineers are helping transform health care. Through its connections to Vanderbilt University Medical Center—ranked No. 1 in the state by U.S. News & World Report—School of Engineering faculty, students and researchers are addressing one of the world's most critical needs.


Shown: Dr. Peter Konrad performing DBS surgery at Vanderbilt University Medical Center

For the approximately 1 million Americans who live with Parkinson's disease, deep brain stimulation therapy can offer hope and relief. Among the first medical centers in the U.S. to test and use DBS, Vanderbilt remains one of the nation's most active and cutting-edge academic centers using DBS to treat neurological disease.

Benoit Dawant , Cornelius Vanderbilt Professor of Engineering, professor of electrical engineering, and director of the new Vanderbilt Initiative in Surgery and Engineering, works with Dr. Peter Konrad and an interdisciplinary team working to improve both technique and technology. They have developed a suite of software to allow surgeons to centralize data and provide assistance at all three stages of DBS therapy—the pre-operative stage to localize the area of implantation, the intra-operative stage to place the electrode, and the post-operative stage to adjust programming parameters—reducing the time needed at each stage and maximizing the efficiency of the entire process.

The system includes a central repository called CranialVault and a suite of software modules called cRAnialVault Explorer (cRAVE). The system permits data entry and data visualization at each stage and includes a series of algorithms that permits the aggregation of data acquired from many patients and the computation of statistical maps. The system is currently being evaluated clinically at Vanderbilt University Medical Center, located only a few steps away from the School of Engineering.

That proximity is no coincidence—it's part of the interdisciplinary life of Vanderbilt engineers and their VUMC counterparts. In fall 2011, the school launched the new Vanderbilt Initiative in Surgery and Engineering. ViSE brings together engineers and physicians from across campus and disciplines to develop and refine innovative surgical solutions that include robotic-assisted placement of cochlear implants; robotic-assisted, minimally invasive procedures; image-guided liver, kidney and brain surgery; bionic limb prostheses; novel drug delivery to the optic nerve; steerable needles; and steerable catheters or endoscopic capsules.

ViSE is supported by federal and corporate funding and includes 22 faculty plus undergraduates, graduate students and postdocs from multiple departments in Vanderbilt's Schools of Engineering and Medicine, as well as collaborators from leading institutions across the world.

The new center is also structured to work with industrial partners to commercialize the intellectual property it generates, provide early evaluation of industrial devices and techniques, and collaborate on innovative solutions for interventional health care processes.

The CRAVE project is supported by National Institutes of Health awards R01-EB006136 and R41NS063707. ViSE projects and researchers are also supported by NIH awards R01CA162477; R01EB006193; R01HD059832; R01NS049251; R21HD068753; R21NS070136; R21RR025806; R41NS063705; and 5R01DC010184.

The interdisciplinary culture of the Vanderbilt School of Engineering allows health care solutions to be created across engineering disciplines, including biomedical, computer, chemical and biomolecular and mechanical. Here are some current examples.


Dread-free Colonoscopy

The most effective method of colorectal cancer screening, colonoscopy is estimated to have the potential to prevent about 65 percent of colorectal cancer cases. The survival rate of those diagnosed with cancer can reach 90 percent in cases diagnosed early.

There are many reasons why half the American public doesn't get screened for colon cancer, the third leading cause of cancer death, but Assistant Professor of Mechanical Engineering Pietro Valdastri aims to eliminate several of the most challenging ones. Valdastri and Dr. Keith L. Obstein , assistant professor of medicine in VUMC's Division of Gastroenterology, are working on an endoscopic capsule robot for painless colonoscopy. The new colonoscopy procedure could bypass the need for sedation and uncomfortable, time-consuming advance preparations.

The process uses a magnetic air capsule robot that measures only 26 millimeters by 11 millimeters. Magnets outside the body guide the tiny MAC through the colon to find potential trouble spots, eliminating the need for a rigid device that must be forced into the body. The MAC receives power and control input from a soft tether and can transmit images for real-time viewing and therapy. An external robotic arm is used to control the magnet in a reliable and repeatable way. In addition to the advantages of robotic control over locomotion and orientation, the system has the potential to be disposable and its small size reduces the risk of looping and perforations.


Diagnostics Made Simple

How can medical personnel perform diagnostic tests in rural clinics around the world without sophisticated medical equipment, electricity or water? An interdisciplinary Vanderbilt team has developed a deceptively simple sample collection and preparation system called the Extractionator that received a $1 million grant from the Grand Challenges in Global Health initiative of the Bill & Melinda Gates Foundation. Rick Haselton , professor of biomedical engineering, David Wright , associate professor of chemistry, and Ray Mernaugh , research associate professor of biochemistry, conceptualized a length of clear plastic tubing filled with a series of liquid chambers separated by short lengths of air. At one end, the tube also contains a number of magnetic beads with special coatings that bind with the specific biological molecules that need to be extracted from the patient sample for a given diagnostic test. Faculty from the School of Engineering, College of Arts and Science and School of Medicine have explored how the system works with biomarkers for the RSV respiratory virus and for malaria, and found that their system is effective. The Gates grant will allow the team to explore using the system for more tests and to advance the project further. They're also developing a partnership with a Chinese company to develop the system for HIV testing.

Graduate student Nick Adams, a team member instrumental to the project, is supported by an NIH Vascular Biology Training Grant and an NSF training fellowship.


Improving Thyroid Outcomes

The parathyroid glands—four tiny, rice-sized organs located at the back of the throat—are so small that they are unseen and often damaged when surgeons remove diseased thyroid glands. They also glow with a natural fluorescence in the near infrared region of the spectrum. Their unique fluorescent signature was discovered by Anita Mahadevan-Jansen, Orrin H. Ingram Professor of Engineering, and a team of biomedical engineers and endocrine surgeons working in the Biomedical Photonics Laboratories. That collaborative discovery is the basis of a simple, reliable and newly licensed optical detector that can allow surgeons to see and avoid the parathyroids. Because the parathyroids regulate calcium concentrations in bones, kidneys and intestines, averting damage prevents lifelong health issues.


High-Tech Bone Healingguelcher

What started as a way to care for the past decade's 50,000 or so soldiers wounded in action now provides a high-tech method to heal and strengthen fractures. Associate Professor of Chemical and Biomolecular Engineering Scott Guelcher works in orthopedic tissue engineering, creating polyurethane scaffolds that can be injected as liquid into an open fracture site to mold to the shape of a wound and sustain tissue repair and weight support. The biomaterial encourages new cells and tissue to form while it naturally degrades, allowing complete repair without additional surgeries. Antibiotics and growth factors can be added to the mixture to prevent infection and promote healing. The technology has been licensed to Medtronic Inc. and is under commercial development. In addition, these injectable therapies will also benefit orthopedic trauma patients and those with metastatic bone disease.

Guelcher's orthopedic tissue engineering work has been supported by Department of Defense/Armed Forces Institute of Regenerative Medicine (AFIRM) funding (W81XWH-08-2-0034); the DOD Orthopaedic Extremity Trauma Research Program (W81XWH-07-1-0211); and a NSF CAREER award (DMR-0847711).

Shown: Guelcher at work in his biomaterials and tissue engineering laboratory


Redefining Heart Intervention

merrymanOut to prove there's more than one way to fight heart disease, David Merryman, assistant professor of biomedical engineering, conducts multipronged research into valvular heart disease. One prong focuses on cardiovascular mechanobiology, studying the effect of transforming growth factor-beta 1 (TGF-β1) on heart valve disease through a grant from the National Institutes of Health. Merryman, a 2012 participant in the National Academy of Engineering's U.S. Frontiers of Engineering symposium, is also working on nondrug methods of fighting the disease. He and his team have developed a percutaneous catheter which one day may take the place of open-heart surgery for certain types of heart valve disease. 

The catheter research conducted by David Merryman's lab was funded by the Wallace H. Coulter Foundation. The valve drug project is funded by the American Heart Association and NIH.

Shown: Merryman and Ph.D. student Steve Boronyak demonstrate a percutaneous catheter


Photos, from top: Anne Rayner; Daniel Dubois; John Russell