Rob McAlpine Legacy Initiative
Cutting Edge NeuroTechnologies for Improved Neurological Health:
High Intensity Focused Ultrasound (HIFU) Proposal
High Intensity Focused Ultrasound (HIFU)
Rob McAlpine Legacy Initiative
Rob McAlpine is an outstanding individual to family, friends, business colleagues and the community. He has
been a well-respected executive at Spartan Controls and is a great friend to many people in Calgary and the
community.
Rob has a degenerative neurological disorder known as multiple system atrophy (MSA) that is associated
with the degeneration of nerve cells in specific areas of the brain. MSA impairs multiple functions or systems
including blood pressure, heart rate, bladder function, and digestion. The condition shares many Parkinson’s
disease-like symptoms such as slowness of movement, muscle rigidity, and poor balance as well as cerebellar
symptoms like impairment of movement, deterioration of speech, and difficulty swallowing. There is
currently no cure as the condition progresses steadily over time and eventually is terminal.
Close friends and business associates through his years of service as VP Finance and CFO at Spartan and his
involvement in the Chartered Accountant profession are proposing to establish a legacy in recognition of
Rob. The objective of this initiative is to help fund significant medical research initiatives of relevance to MSA
and related disorders and diseases, and seek to support organizations that provide family counselling and
other forms of support for those suffering from these disorders and diseases.
Initially a medical research opportunity has been identified in association with the Hotchkiss Brain Institute
(HBI) which involves support to acquire a highly promising piece of equipment called a High Intensity
Focused Ultrasound (HIFU) unit. The legacy initiative’s initial interest, which has been discussed with Rob, is
to work collaboratively with the HBI to fund this unit for purchase in 2015 in honour of him. Additionally the
legacy initiative hopes to establish further funds, and in further collaboration with Rob and his family,
consider forming a foundation in Rob’s or his family’s name for longer term support of family support
organizations related to MSA and related disorders and diseases, or further medical research opportunities.
High Intensity Focused Ultrasound (HIFU)
New technology to solve health problems
Not long ago, medical imaging was limited to diagnostic X-rays, once a revolutionary tool. In a relatively
short period of time, the field of imaging has exploded with new technologies like Magnetic Resonance
Imaging (MRI), ultrasound, and functional MRI (fMRI) – enabling scientists to not only see the structure of
the brain in detail but also visualize the mind as it’s thinking. As our ability to understand brain processes has
increased, so has our understanding of the mechanisms of disease.
For example, in some cases we have been able to isolate the specific area of the brain responsible for
tremors in individuals with Parkinson’s and other related movement disorders. The same is true for those
suffering from seizures. Armed with this knowledge, clinicians have been treating specific areas of the brain.
In fact, a neurologist now at the Hotchkiss Brain Institute was the first person in the world to conclusively
prove the benefit of brain surgery to successfully prevent seizures in people suffering from severe epilepsy.
That research and its subsequent transfer to standards of care – have improved the lives of thousands of
people around the world.
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High Intensity Focused Ultrasound (HIFU)
For movement disorders like Parkinson’s disease where deep brain structures are implicated, the greater
challenge has been accurately approaching these structures through surgical treatment, without damaging
the overlying brain tissue and blood vessels. The evolution of imaging techniques has enabled
neurosurgeons to perform minimally invasive surgery via small holes drilled in the skull, an important tool in
the treatment of movement disorders. Current surgical techniques can involve precise destruction of a small
area of the brain or implantation of electrodes for subsequent long-term tissue stimulation, the latter known
as Deep Brain Stimulation (DBS). However, these minimally invasive neurosurgeries are complex, expensive,
and not without complications. Although potentially successful, patients are still faced with the terrifying
decision to undertake highly invasive brain surgery to hopefully recapture their quality of life.
Imagine brain surgery without a scalpel – this seemingly unlikely idea is now a reality.
Ushering in a new era in the treatment of neurological illness
In the last twenty years, technological breakthroughs have been made in the field of high intensity focused
ultrasound (HIFU), combined with the accurate guidance of MRI, that now make it possible to precisely and
selectively affect the tiniest and deepest portions of the brain in an entirely noninvasive fashion. While
regular ultrasound is a completely safe technology that is used routinely around the world to image inside
the body, the same technology, but more focused and intense, can be used to heat and destroy tissue in an
extremely precise manner for the purposes of treatment rather than just diagnosis.
The idea of HIFU is comparable to using a magnifying glass to focus sunlight onto a small spot that will
become very hot. Because no radiation is used and no overlying tissue is damaged, the technology is very
appealing for targeting deep brain structures to treat movement disorders and other neurological
conditions.
MRI has also been critical to the development of HIFU-based neurosurgery, since it enables the targeted
areas of the brain to be accurately identified. In its current application, a large number of ultrasound beams
are focused on a target deep in the brain, and painlessly pass through the skull as an individual lies in an MRI
scanner. The MRI scanner can map the brain temperature and monitor the course of the HIFU treatment in
real-time while the awake patient communicates with the surgical team.
The truly groundbreaking nature of HIFU-based neurosurgery – the combination of ultrasound and MRI
technologies to create a surgical outcome – is a breakthrough with the capacity to change the way we treat a
number of neurological illnesses. The illnesses with the greatest likelihood of being positively impacted by
this technology are the movement disorders known as Parkinson’s disease and tremor.
As HIFU-based technologies are further advanced, the applications are likely to expand. Through clinical
research, we envision creating opportunities to treat epilepsy, brain tumours and perhaps mental illness –
the potential to create improved health outcomes by merging previously independent imaging techniques is
limitless and breathtaking.
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High Intensity Focused Ultrasound (HIFU)
Paving the way for new technology to improve the neurological health
of our community
At the University of Calgary’s Hotchkiss Brain Institute, we see this emerging new technology as a high
priority and we know that we have the team of scientists and physicians who will conduct the research
necessary to enable the realization of its potential. Through collaborative efforts with the Departments of
Clinical Neurosciences and Radiology, we will focus our cutting edge research efforts in the further
development and application of HIFU-based neurosurgery to treat Parkinson’s disease, as well as other
neurological and psychiatric conditions.
Clinical research indications – now and in the future
The HIFU device is an experimental system and is not currently approved by Health Canada so each
and every indication will require a specific research protocol to allow us to use the device in
patients. The vendor (InsighTec) will assist the University of Calgary and Alberta Health Services to
secure Health Canada approved protocols. It is anticipated that the device will become FDA and
Health Canada approved for specific procedures in 2015.
Although the list of neurological diseases treatable by HIFU is preliminary, researchers are using this
device for many conditions. It is also hoped that HIFU procedures will eventually replace other,
more expensive, surgical treatments currently used. The clinical research indications under
investigation for HIFU include:
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Essential tremor (uncontrollable shaking of the limbs of unknown cause)
Tremor associated with Parkinson’s disease
L-DOPA induced dyskinesia (writhing movements associated with medication side-effects)
Selected seizure or epilepsy conditions
Trigeminal neuralgia (severe facial pain)
Hemorrhagic stroke such as intra-cerebral hematomas
Psychiatric disorders
• Enhancing chemotherapy for brain tumors
Operational overview
The HIFU system would be housed at the Seaman Family MR Research Centre located at the
Foothills Medical Centre. The Centre represents a unique clinical research collaboration between
the University of Calgary’s Faculty of Medicine and Alberta Health Services. The Centre houses a
powerful General Electric 3 Tesla MRI scanner that is compatible with the Insightec HIFU Unit. The
HIFU unit itself surrounds the patient’s head and fits inside the MRI scanner. When it is not in use,
it is easily removed from the scanner and other MRI studies can be performed as normal.
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High Intensity Focused Ultrasound (HIFU)
Patients will require a pre-procedure MRI and CT scan. The latter is critical for planning HIFU
procedures since the thickness of the skull along with calcium deposits in the brain must be
accounted for to avoid undesired heating or poor targeting. Based on the pre-procedure CT and
MRI, patients are carefully selected for their appropriateness for HIFU therapy.
The workflow on the day of procedure involves the application by the neurosurgeon of a pin-based
stereotactic frame around the patient’s head, which is already available in Calgary. The patient will
then go to the 3T MRI suite at the Seaman Family MR Research Centre. A typical case takes 3 hours
but could range from 1½ to 5 hours within the scanner itself. As the technology continues to
develop, case times are expected to shorten.
A neurosurgeon and medical physicist or imaging expert do initial targeting based on the preprocedure scans and this is verified on the scans collected during the procedure. A medical
physicist typically runs the software provided with the device. A technical representative of the
company is also required on an ongoing basis until Health Canada approval is received. A
movement disorder neurologist or neurosurgeon checks on the patient periodically as the lesion is
being generated. An MRI technician does multiple scans during the case to monitor the treatment
and then does a post-lesion MRI scan to verify the lesion.
The Team
The HIFU clinical research program will be a joint initiative between the HBI and the Departments
of Clinical Neurosciences (Division of Neurosurgery) and Radiology. Dr. Yves Starreveld will be the
lead neurosurgeon and Dr. Bruce Pike will be the lead imaging scientist. In addition to his extensive
clinical training, Dr. Starreveld obtained his PhD in Medical Biophysics from Western University
working on computerized methods for stereotactic functional neurosurgery. Dr. Pike is a world
authority on neuroimaging research and has worked on image-guided neurosurgery for over 25
years. In addition to their academic work, Drs. Starreveld and Pike have independently created
spin-off companies based on their image-guided neurosurgery research. A medical physicist
specializing in high intensity focused ultrasound will also be a key member of the team. This staff
scientist will have expertise in ultrasound physics, MRI-based temperature mapping, and imageguided neurosurgery methods. This individual will be 100% dedicated to this program and will be
responsible for the day-to-day running of the program including establishing standard operating
procedures, working with the manufacturer to obtain Health Canada and Research Ethics approval
of all studies, quality assurance of equipment, running the instrument during experiments and
treatments, and maintaining a comprehensive database of all treatments and outcomes. A
postdoctoral fellow, jointly supervised by Drs. Starreveld and Pike, will work on specific research
projects and be responsible for subject recruitment, clinical and imaging data analysis, and
manuscript preparation.
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High Intensity Focused Ultrasound (HIFU)
Financials
Capital equipment costs are estimated at $1.5M and an upgrade is planned for Year 6. Annual
operating costs are anticipated to be $300k - $400k including maintenance contract, personnel, and
scanner operating cost.
Impact
The implementation of this HIFU clinical research program will have a number of important
benefits. First and foremost, we will introduce and develop a new treatment approach for Alberta
patients suffering from movement disorders and a range of other neurological diseases.
Parkinson’s disease alone afflicts approximately 100,000 Canadians and new treatments are
urgently needed. We believe our HIFU clinical research program will also help usher this new
technology into use nationally and internationally thereby having a profound effect on the quality
of life of many more patients.
The HIFU program will also stimulate the research of many other HBI/UofC scientists who will bring
their expertise to the program to further advance our understanding of brain health and disease.
Focused ultrasound, at a much lower intensity than used for lesioning, has recently been used
stimulate the brain. This capability would provide limitless possibilities for studying brain function
and enormous potential for treating an even greater range of neurological and psychiatric
conditions. Research in these areas will also result in significant economic benefit, as new research
funding will be secured, new research trainees attracted, and new intellectual property generated.
Rare is the opportunity to be on the forefront of innovation that can change lives. We are seeking
community support in our endeavour to improve the health of Albertans through the application of
new imaging and treatment technologies. We invite your participation in this exciting project.
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High Intensity Focused Ultrasound (HIFU)
About the Hotchkiss Brain Institute
The Hotchkiss Brain Institute is a centre of excellence in neurological and mental health research and education,
translating discoveries into innovative health care solutions. Connecting more than 700 researchers, doctors, clinicianscientists, trainees and staff, the HBI is working to train tomorrow’s leaders in neurological and mental health research
and care in an enriched environment that includes undergraduate and graduate education, and post-doctoral and postgraduate medical research programs that houses more than 300 students and fellows.
The HBI is key to the University of Calgary’s Eyes High vision of becoming one of Canada’s top five research universities,
is grounded in innovative learning and teaching and is fully integrated with the community of Calgary.
About the Department of Clinical Neurosciences
The Department of Clinical Neurosciences is a nationally and internationally-recognized program dedicated to
advancing the health of neurological patients through innovative treatments, research, and education. The department
is made up of four divisions: neurosurgery, neurology, physical medicine and rehabilitation, and translational
neuroscience. Almost 100 faculty members who are physicians and scientists were recruited to Calgary from around the
world to conduct and promote clinical and basic science research into diseases of the nervous system. Through the
development and testing of new forms of treatment, we explore mechanisms of disease and provide subspecialized
care and therapy to patients affected by diseases of the brain, spine, and nerves.
About the Department of Radiology
The Department of Radiology, based at the Foothills Medical Centre, leads Calgary’s medical and research efforts in
human imaging. Neuroimaging is a key strength of the department and is aided and elevated by state-of-the-art
technology housed within the Seaman Family MR Research Centre, the Pediatric 3T Imaging Program, and the
Experimental Imaging Centre. The recent recruitment of Dr. Bruce Pike – to lead human brain imaging research – is
expanding the depth and breadth of our efforts and collaborations with the ultimate goal of improving the prevention
and treatment of neurological and mental illness.
For further information, please contact:
Dr. Samuel Weiss
Director, Hotchkiss Brain Institute
3330 Hospital Drive NW
Calgary, AB T2N 4N1
T: 403.220.3994
E: [email protected]
Janelle Wakaruk
Director, Fund Development
3330 Hospital Dr NW
Calgary, AB T2N 4N1
T: 403.220.6161
E: [email protected]
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