Immune outposts inside tumors predict post-surgery outcomes

The immune system establishes “forward operating bases”, or lymph node-like structures, inside the tumors of some patients with kidney and other urologic Read more

Hedgehog pathway outside cilia (with CBD bonus)

The Hedgehog pathway has roles in both specifying what embryonic cells will become and in guiding growing neural Read more

Tracking how steroid hormone receptor proteins evolved

When thinking about the evolution of female and male, consider that the first steroid receptor proteins, which emerged about 550 million years ago, were responsive to estrogen. The ancestor of other steroid hormone receptors, responsive to hormones such as testosterone, progesterone and cortisol, emerged many millions of years later. Biochemist Eric Ortlund and colleagues have a new paper in Structure that reconstructs how interactions of steroid receptor proteins evolved over time. This is a complex Read more

Department of Radiology and Imaging Sciences

Radiologists wrestle with robots – ethically

Radiologists look at and analyze images, tasks computer algorithms can do. This is fertile soil for artificial intelligence (AI) — enough so that some predict that AI will replace radiologists.

John Banja, PhD

Emory bioethicist John Banja says: don’t believe the hype. AI will generate tools radiologists will want to use, he says. But human experts will have plenty to do, including making sure that the algorithms are properly vetted and trained on appropriate data.

“We already know what a lot of the ethical issues are going to be…informed consent, privacy, data protection, ownership, all that kind of stuff,” Banja recently told Health Imaging. “What we need to do is drill down to the next level, especially the practice level.”

Banja has received a grant from the Advanced Radiology Services Foundation to support a series of podcasts with radiologists over the next two years. He will be teaming up with Emory radiologist Rich Duszak, a specialist in health policy, and Norm Beauchamp, medical dean at Michigan State.

Banja and Duszak are still planning podcast sessions and lining up interviews, but they said the first episode will be on “AI hype”, and the second will cover standard of care/medical malpractice, with future issues on FDA standards.

Duszak comments on how radiologists need to take control of the algorithms in this video.

Also, with radiology chair Carolyn Meltzer, Banja recently published a review on ethics related to radiology and AI, exploring issues such as selection bias and stretching algorithms too far. Read more

Posted on by Quinn Eastman in Uncategorized Leave a comment

FDA approves Emory-developed cancer imaging probe

A cancer imaging agent that was originally developed at Emory was approved on Friday, May 27 by the U.S. Food and Drug Administration.

Axumin, a PET (positron emission tomography) imaging agent, is indicated for diagnosis of recurrent prostate cancer in men who have elevated PSA levels after previous treatment. Axumin, now being commercialized by UK-based Blue Earth Diagnostics, is also known as 18F-fluciclovine or FACBC (an abbreviation for anti-1-amino-3-[18F]fluorocyclobutane-1- carboxylic acid).

goodman-schuster

Mark Goodman, PhD (left) and David Schuster, MD (right)

Imaging using axumin/fluciclovine is expected to help doctors detect and localize recurrent prostate cancer, and could guide biopsy or the planning of additional treatment. Fluciclovine was originally developed at Emory by Mark Goodman and Timothy Shoup, who is now at Massachusetts General Hospital.

The earliest research on fluciclovine in the 1990s was on its use for imaging brain tumors, and it received a FDA “orphan drug” designation for the diagnosis of glioma in 2015. About a decade ago, Emory researchers stumbled upon fluciclovine’s utility with prostate cancer, while investigating its activity in a patient who appeared to have renal cancer, according to radiologist David Schuster, who has led several clinical studies testing fluciclovine.

“This led us to see if this radiotracer would be good for looking at prostate cancer, specifically because of its low native urinary excretion,” Schuster is quoted as saying in the radiology newsletter Aunt Minnie. “If you look at the history of medical science, it is taking advantage of the unexpected.”

Early research on the probe was supported by Nihon Mediphysics, and later support for clinical research on FACBC/fluciclovine came from the National Cancer Institute, the Georgia Research Alliance and the Georgia Cancer Coalition. [Both Emory and Goodman are eligible to receive royalties from its commercialization]. Additional information here.

References for two completed studies on fluciclovine in recurrent prostate cancer

Odewole OA et al. Comparison with CT imaging (2016) 

Schuster DM et al. Head to head comparison with ProstaScint (2014). Read more

Posted on by Quinn Eastman in Cancer Leave a comment

Promising probe for detecting recurrent prostate cancer

Part of the new Winship magazine feature on prostate cancer focuses on a PET imaging probe called FACBC, which was developed by radiologists at Emory. 18F-FACBC (anti-1-amino-3-[18F]fluorocyclobutane-1-carboxylic acid, also called “fluciclovine”) has a lengthening track record in detecting recurrent prostate cancer.

Structure of FACBC, from patent application.

Usually in PET imaging, radioactive glucose is injected into the body, and since cancer cells have a sweet tooth, they take up a lot of the radioactive tracer. But plenty of the tracer also appears in the urine, complicating prostate cancer detection efforts, since the prostate is so close to the bladder. In contrast, FACBC is readily taken up by prostate cancer cells, but doesn’t appear as much in urine.

Because of space considerations, we did not include David Schuster’s description of how FACBC’s utility in prostate was first discovered. Several years ago, he and Mark Goodman had begun investigating the probe’s potential in imaging brain tumors and kidney tumors, and used it with a patient with a large renal mass and many enlarged lymph nodes, as described in the radiology newsletter Aunt Minnie. Read more

Posted on by Quinn Eastman in Cancer Leave a comment