Prof. Wladyslaw “Wady” Gedroyc, MBBS, MRCP, FRCR is a consultant radiologist at St. Mary’s Hospital, Imperial College National Health Service (NHS) Trust, and has been a champion of focused ultrasound for more than 20 years. He has used focused ultrasound to treat over 800 patients, beginning with women with uterine fibroids for many years and, more recently, patients with essential tremor and tremor-dominant Parkinson’s disease.
We interviewed Prof. Gedroyc to learn more about his pioneering career in focused ultrasound. Read the following Q&A to hear how he first learned about focused ultrasound, his long-term research, and his fruitful collaborations.
When and how did you get interested in focused ultrasound?
I was first involved with MR-guided interventional work using an MR scanner to carry out a variety of percutaneous thermal ablation procedures. The work we were doing in this area in fibroids was obviously applicable to the newly emerging field of MR-guided focused ultrasound, and it was our original work in percutaneous thermal ablation of fibroids that led me to suggest that focused ultrasound could also be used for this purpose. We then treated the world’s first uterine fibroid patient with focused ultrasound in the year 2000. Having seen first-hand the potential of focused ultrasound to replace a great deal of conventional invasive therapeutic procedures for the great benefit of our patients, I became deeply engaged in this field.
What are your areas of interest in focused ultrasound?
I am interested in using focused ultrasound for uterine fibroid treatment, facet joint treatment, liver treatment, and brain applications, such as treatment of essential tremor and tremor dominant Parkinson’s disease. I am also studying the use of focused ultrasound in the activation of drugs at local sites within the body, including the brain, to be able to treat brain tumours and possibly Alzheimer’s disease in the future.
What mechanisms and clinical indications do you study?
Most of my initial work in focused ultrasound has involved studying thermal ablation procedures and their clinical results, and this remains a primary goal and interest. However, now we are purely doing brain work, which is an area of unmet need and profoundly successful. For the brain, we are studying the following clinical indications:
- Essential tremor thalamotomy (unilateral and bilateral)
- Parkinson’s dyskinesia pallidotomy
- Drug delivery for oncology (preclinical research)
Importantly, we have a large backlog of patients who are seeking treatment for movement disorders. However, over the last years I have been deeply involved in a variety of projects looking at focused ultrasound for local drug applications and in using focused ultrasound to increase the uptake of drugs within tumours. This work has led to the patenting of several new drug formulations that have been developed within my group. We expect the evolution to first-in-human work to happen over the next few years, followed by commercialization of these developments.
What is the goal of your work?
My goal is to convert many currently utilized surgical and interventional procedures into completely non-interventional outpatient procedures, which would immensely benefit our patients in terms of greatly reduced morbidity and mortality. This will also benefit patients by keeping them out of hospitals and reduce the cost and burden on our financially strapped health services. Now focusing on the brain, we can offer noninvasive treatments for conditions that so far are treated with deep brain stimulation or open surgery to patients who no longer respond to medication. Apparently, this is a great relief for these patients and very gratifying to see as a treating physician.
What are your funding sources?
All our research funding is from the NHS Trust, industry partners, and charitable donations – especially for the capital equipment. Imperial College NHS Trust charity very generously funded the purchase of our focused ultrasound brain system. We are now in positive discussions with them to also fund the low frequency brain system that would enable us to advance our work to deliver drugs to the brain. We do not have a budget designated specifically for focused ultrasound. Part of our ongoing brain clinical work is now funded directly by the NHS for patients with refractory essential tremor. Some of the cases that we do are private pay.
Who are your team members and your internal and external collaborators?
Although none of us work full time in focused ultrasound, we have a group of nine professionals who are currently a part of the focused ultrasound program, including the following individuals:
- Professor Wladyslaw Gedroyc, MBBS, MRCP, FRCR (consultant radiologist)
- Peter Bain, MBBS, MA (Oxon), MD, FRCS, a neurologist
- Dipankar Nandi, MBBS, a neurosurgeon
- Brynmor Jones, MBBS, a neuroradiologist
- Ayesha Jameel, MBBS, MRgFUS clinical research fellow
- Four radiography technicians who operate the focused ultrasound systems
Furthermore, we have our imaging research coordinators and nurses, who are extremely helpful and without whom we would be lost. The people who fill these roles are vital to our program.
In the drug activation program, we work closely with Professor Maya Thanou, PhD, and her group at King’s College London.
What are your greatest achievements? Any major disappointments?
Initiating the fibroid focused ultrasound work was immensely gratifying because it has been taken up and expanded on a worldwide basis. More recently, making the case for reimbursement of focused ultrasound treatment of essential tremor and pushing it through the NHS bureaucracy has been extremely nerve wracking and time consuming. But eventually succeeding to secure reimbursement and being able to help these patients has been equally rewarding. Our immensely promising work in drug activation, which will potentially change the way we deliver therapy to patients with malignancies, is also exciting. We have encountered our share of disappointments along the way as well. Our centre faced a difficult internal political situation for a few years, which decreased the size of my research team, tightened financial constraints, and stalled our work in using focused ultrasound to treat facet joint pain and uterine fibroids. These challenges stifled innovation and creativity, but the situation has evolved, and we are now poised for progress.
What do you see as impediments to your success?
Ongoing financial constraints have led to a complete change in the environment in which many of us develop new procedures. An overwhelming and increasingly intrusive bureaucracy has been created both locally and nationally that has made all aspects of research more difficult. Research has become much more expensive, and more competition for fewer resources has created a vicious cycle that impedes development of medical devices and their applications. A simple example would be that the costs to undertake a randomized device trial are so high that they deter investment from both independent funding bodies and device manufacturers.
What is your research wish list?
My research wish list is technology that will allow us to start to treat brain tumours and liver tumours with focused ultrasound.
Has the Foundation played a role in your work?
The Focused Ultrasound Foundation has been key in the continued evolution and promotion of focused ultrasound on a worldwide platform. On a personal level, the Foundation has funded some of the projects that allowed me to develop focused ultrasound as a treatment for facet joints. The Foundation has often provided the infrastructure to allow me to network with many invaluable colleagues around the world who have helped the progress of my work.
How many patients have you treated?
I have treated more than 800 patients with focused ultrasound. The majority have been women with fibroids, but a substantial minority has been in other areas, including facet joint, liver, bone, and miscellaneous soft tissue masses. Since we started the brain program, we have treated 80 patients and continue doing so with about one patient per week.
Do you have any clinical or clinical research highlights?
Some years ago, we performed a first-in-the-world treatment on a 6-year-old girl with a large, benign, slow growing, and inoperable pelvic tumour. As for more recent highlights, the brain cases are remarkable, and we have had a series of incredible results for patients whose lives were truly destroyed by movement disorders. We also performed the world’s first bilateral treatment for essential tremor, further improving tremor symptoms. It is a medical miracle to watch the treatment work in these patients.