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Multimodal Fluorescence- and Imaging-Guided Surgical Navigation: Developing Methods for Subsurface, Indirect Visualization of Cancers Requiring Wide Local Excision

Award Number: K23EB026507
ORGANIZATION: NATIONAL INSTITUTE Of BIOMEDICAL IMAGING & BIOENGINEERING
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: TRAINING/TRAINEESHIP

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Project Summary The primary goal of cancer surgery is to cure patients of their tumors. One of the oncological surgeon’s greatest challenges is to successfully distinguish cancer tissue from non-cancer tissue. Fluorescence- guided surgery has radically changed the surgeon’s ability to make this determination, with demonstrably better outcomes; however, fluorescence guidance is currently only applicable in the setting of tumors that are near their parent organ’s surface, such as the throat or bladder, or cancers that are removed piecemeal, such as brain tumors. In both of these scenarios, the tumor is visualized directly with surface- based fluorescence guidance. Many cancers, such as the sarcomas that I treat in clinical practice, are removed ideally with a zone of normal tissue surrounding the tumor; this zone is referred to as the margin. This type of surgery is called a wide local excision and the success or failure of the surgery is determined by the presence or absence of cancer cells at the cut surface of the removed specimen, which is reviewed by a pathologist. The pathologist will classify the margin as positive, where cancer cells are present at the specimen’s surface—a failed wide local excision, or negative, where only normal tissue is present at the specimen’s surface—a successful wide local excision. Based on published reports, failed wide local excisions occur about 20-25% of the time, which have negative effects on patient outcomes. Applying fluorescence guidance to wide local excision surgeries holds the promise of providing real-time feedback to surgeons regarding the distance from their instruments to the tumor’s surface, thereby instructing the surgeon as to the thickness of the margin and helping avoid a failed surgery—such a change in practice would be revolutionary. Fluorescence-guided surgery for cancers requiring wide local excision is possible in theory; however, it would require that the cancer’s location be monitored via indirect, subsurface fluorescence guidance, which is not possible with current technology. I am a fellowship-trained musculoskeletal oncology surgeon, a subspecialty of orthopaedics dedicated to the surgical treatment of patients with bone and soft-tissue sarcomas that generally require radical, limb- sparing operations. I believe that fluorescence-guided surgery holds tremendous promise for treating patients with sarcomas and other cancers requiring wide local excision. I have completed seminal work to address knowledge gaps that must be filled in order to translate this concept into practice, however, I realize the limits of my knowledge and skills and understand that in order to pursue my career goals I require additional training. Through this award I will pursue mentored research and didactics in biomedical optics, advanced imaging technology, and clinical research design that will enable me to transition from a junior clinical researcher into an independent clinician-scientist and achieve my primary career goal: to facilitate meaningful and transformative research for patients with sarcoma.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2023 ( Subtotal = -$20,387 )
2023	2021	DARTMOUTH-HITCHCOCK CLINIC	ONE MEDICAL CENTER DR	LEBANON	NH	03756	GRAFTON	USA	Discovery and Applied Research for Technological Innovations to Improve Human Health	000	5	1/19/2023	NON-COMPETING CONTINUATION	-$20,387
														Subtotal = -$20,387

Issue Date FY: 2022 ( Subtotal = $0 )
2022	2021	DARTMOUTH-HITCHCOCK CLINIC	ONE MEDICAL CENTER DR	LEBANON	NH	03756	GRAFTON	USA	Discovery and Applied Research for Technological Innovations to Improve Human Health	000	5	9/7/2022	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2021 ( Subtotal = $169,727 )
2021	2021	DARTMOUTH-HITCHCOCK CLINIC	ONE MEDICAL CENTER DR	LEBANON	NH	03756	GRAFTON	USA	Discovery and Applied Research for Technological Innovations to Improve Human Health	002	5	8/18/2021	NON-COMPETING CONTINUATION	$169,727
2021	2020	DARTMOUTH-HITCHCOCK CLINIC	ONE MEDICAL CENTER DR	LEBANON	NH	03756	GRAFTON	USA	Discovery and Applied Research for Technological Innovations to Improve Human Health	001	4	8/11/2021	NON-COMPETING CONTINUATION	$0
2021	2020	DARTMOUTH-HITCHCOCK CLINIC	ONE MEDICAL CENTER DR	LEBANON	NH	03756	GRAFTON	USA	Discovery and Applied Research for Technological Innovations to Improve Human Health	000	4	5/20/2021	NON-COMPETING CONTINUATION	$0
														Subtotal = $169,727

Issue Date FY: 2020 ( Subtotal = $169,555 )
2020	2020	DARTMOUTH-HITCHCOCK CLINIC	ONE MEDICAL CENTER DR	LEBANON	NH	03756	GRAFTON	USA	Discovery and Applied Research for Technological Innovations to Improve Human Health	000	4	7/28/2020	NON-COMPETING CONTINUATION	$169,555
														Subtotal = $169,555

Issue Date FY: 2019 ( Subtotal = $169,736 )
2019	2019	DARTMOUTH-HITCHCOCK CLINIC	ONE MEDICAL CENTER DR	LEBANON	NH	03756	GRAFTON	USA	Discovery and Applied Research for Technological Innovations to Improve Human Health	005	3	7/9/2019	NON-COMPETING CONTINUATION	$169,736
2019	2018	DARTMOUTH-HITCHCOCK CLINIC	ONE MEDICAL CENTER DR	LEBANON	NH	03756	GRAFTON	USA	Discovery and Applied Research for Technological Innovations to Improve Human Health	004	2	2/12/2019	CHANGE OF GRANTEE / TRAINING INSTITUTION / AWARDING INSTITUTION	$5,621
2019	2018	TRUSTEES OF DARTMOUTH COLLEGE	1 HINMAN DARTMOUTH COLLEGE	HANOVER	NH	03755	GRAFTON	USA	Discovery and Applied Research for Technological Innovations to Improve Human Health	002	1	12/21/2018	NEW	$0
2019	2018	DARTMOUTH-HITCHCOCK CLINIC	ONE MEDICAL CENTER DR	LEBANON	NH	03756	GRAFTON	USA	Discovery and Applied Research for Technological Innovations to Improve Human Health	001	2	12/19/2018	CHANGE OF GRANTEE / TRAINING INSTITUTION / AWARDING INSTITUTION	$128,652
2019	2018	TRUSTEES OF DARTMOUTH COLLEGE	1 HINMAN DARTMOUTH COLLEGE	HANOVER	NH	03755	GRAFTON	USA	Discovery and Applied Research for Technological Innovations to Improve Human Health	000	1	12/19/2018	NEW	-$128,652
2019	2018	TRUSTEES OF DARTMOUTH COLLEGE	1 HINMAN DARTMOUTH COLLEGE	HANOVER	NH	03755	GRAFTON	USA	Discovery and Applied Research for Technological Innovations to Improve Human Health	003	1	2/12/2019	NEW	-$5,621
														Subtotal = $169,736

Issue Date FY: 2018 ( Subtotal = $169,752 )
2018	2018	TRUSTEES OF DARTMOUTH COLLEGE	1 HINMAN DARTMOUTH COLLEGE	HANOVER	NH	03755	GRAFTON	USA	Discovery and Applied Research for Technological Innovations to Improve Human Health	000	1	7/11/2018	NEW	$169,752
														Subtotal = $169,752

Grand Total All Awards = $658,383

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Multimodal Fluorescence- and Imaging-Guided Surgical Navigation: Developing Methods for Subsurface, Indirect Visualization of Cancers Requiring Wide Local Excision

Award Number: K23EB026507

ORGANIZATION: NATIONAL INSTITUTE Of BIOMEDICAL IMAGING & BIOENGINEERING

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: TRAINING/TRAINEESHIP

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