How imaging investment is paying off for Western

Dr. Ting-Yim Lee thinks the big numbers could be bigger. Much bigger.

“The public wants to know what the return on its investment is, particularly in the type of tight, fiscal conditions we are facing right now,” said the Schulich School of Medicine & Dentistry professor and Robarts Research Institute scientist. “Every dollar must be spent in a useful way.

“I think this study shows that imaging is a ‘useful way.’”

Lee’s work was the centerpiece of a recent Canada Foundation for Innovation (CFI) study, Pilot Socioeconomic impact analysis of CFI and CIHR funding: Medical imaging R&D. The study pointed to medical imaging not only as “one of Canada’s research and development strengths,” but also as a sound investment for past – and future – federal dollars. Those findings, according to Western imaging advocates, make further argument for the university to remain on the cutting-edge of the discipline.

Between FY 1998-99 and FY 2011-12, Canadian Institutes of Health Research (CIHR), CFI and their provincial and institutional partners invested slightly more than $1 billion in medical imaging R&D and related health research. CFI projects accounted for $565 million of that number; CIHR awards amounted to $468 million.

The CFI study focused on early medical imaging investments among four universities and their affiliated research hospitals including Western, McGill, British Columbia and Toronto. Funding for these institutions was $387 million – $119 million was from CFI and its partners, and $268 million from CIHR.

The finding didn’t surprise Lee, but did make many outside the imaging game take note.

According to the study, Canadian imaging investment has resulted in a benefit-to-cost ratio between 1.5-to-1 and 2.3-to-1, meaning for every $1 invested, $1.50 to $2.30 in value is accrued by the public.

“That number rang very true to me,” Lee said. “But that didn’t stop me from debating with them. I feel the cost benefit is still too low by their calculations.”

Lee believes the study was too conservative in its estimates, and he places Canadian investment return somewhere between 7-to-1, 10-to-1, if you take everyone doing work in the area into account. If you take U.S. researchers into consideration as well, then that number grows to 70-to-1.

“And if you count the whole world,” said Lee, among the first to see the finished report, which has only recently been circulating wider, “then the mind boggles at the possibilities.”

Lee’s work was the focus of the study, which examined computed tomography perfusion, an advanced imaging procedure performed in just a few minutes using scanners readily available in hospital emergency departments. This procedure uses computed tomography (CT) scanners to measure blood flow in organs and tissues and is broadly used in acute stroke diagnosis.

Lee uses CFI infrastructure and CIHR support to analyze acute stroke. GE Healthcare commercialized his research, catalyzing a global sea change in how stroke victims’ conditions are assessed.

“Signing on with GE is good because they have a big footprint in CT scanners around the world,” said Lee of the “mothership” that represents more than 70 per cent of CT scanners worldwide.

The equivalent monetary value to Canadians attributable to public support of CT perfusion is $87 million-$130 million from 2000-11. When the benefits are compared with all costs, the net benefits are between $42 million-$86 million.

For Lee, the numbers are important, but so is what the numbers say about linking patients to the research.

“Ever since I started at Western, I have been concerned about the dichotomy of the two silos of clinical practice and research,” Lee said. “You could develop a fantastic research method that could tell you fantastic things about the human body, but if no one uses it – if people in a hospital in Timbuktu cannot use it – your practical impact in day-to-day clinical practice and day-to-day patients is going to be limited because no one has advanced imaging equipment, techniques and personnel to use those type of methodologies.”

The study aligns with Western’s research emphasis on imaging.

“People often forget Canada’s first human brain MRI was conducted in London in 1982, and researchers here were the first to show MRI could be used to image a single cell in a living animal,” said Dan Sinai, associate vice-president, research. “Our current and future success is built directly on the back of this history.

“We would have never have been given the opportunity to install one of the world’s largest collections of biomedical imaging tools in London if we hadn’t consistently produced results at the university and hospitals.”

Boasting more than $100 million in imaging infrastructure, including both CT and MRI capabilities, Western’s imaging research touches on 18 departments within five faculties. More than 4,000 undergraduate and 1,100 graduate students work with 273 faculty members in the discipline.

For students, the programs are competitive, with eight undergraduate applicants and seven graduate applicants for one seat. After graduation, however, imaging undergrads have an employment rate of 94.5 per cent.

Among faculty, imaging plays host to 12 research chairs. The average funding among imaging faculty is more than $1.1 million, and they produced 4,256 publications from 2005-13.

Western imaging researchers have spun off seven companies and nearly 50 patents over the past decade.

Among the latest investments, Western put $7 million in CFI and the Ontario Research Funds into upgrading the university’s 3T and 7T functional Magnetic Resonance Imaging (MRI) systems.

“Having this equipment at the core of research across various disciplines allows us to recruit talent and put people with big ideas into better positions to succeed at finding ways to understand, diagnose and treat disease,” Sinai continued.

At the heart of the upgrade is speed – what took five minutes to image on the old system is now possible in less than two. The increase in imaging speed will allow researchers to image populations that weren’t possible before because of their inability to stay stationary for long periods of time. This includes patients in vegetative states, babies and patients with Alzheimer’s disease.

Western is the ultra-high field imaging machines putting not only Western, but Canada on the map for this type of research, said Schulich professor and imaging scientist Ravi Menon.

The upgrade to the 3T system makes it the first of its kind in North America. The 7T continues to be the only one of its kind in Canada. Add in a 9.4T animal scanner, and Western offers a full imaging suite unrivaled by most research institutions.

“Having the full cross-section is still quite rare,” he said. “The expertise requires a fair number of people, and there are not many places in the world with that kind of collective wisdom. We can take problems that maybe have solutions in animal models, and see if it can be solved in the human condition, or vice versa.”

There are more powerful MRI scanners in the world; 11.7T scanners exist for human examination, although those systems have major issues where solutions aren’t even visible. While fine for technical innovation and research, the systems are all but unusable for patient-focused research because of their undependability and questionable health effects on humans.

Menon calls that the distinction between ‘cutting-edge’ and ‘bleeding-edge’ research. He considers the university on the cutting-edge of MRI research – that point where technology and practicality of the technology are at maximum benefit for academic research and clinical application.

And that practicality keeps Western at the front of the pack. “At least it will for six months,” laughed Menon, who said these type of upgrades need to happen every four to five years to stay current.