8
Jul
2019

Banning biopsies through the use of ultrasound technology

Carolina’s passion for creating technological tools to solve clinical problems has turned her into one of the 35 innovative and pioneering MITs under 35 in Latin America. Doctorate in Biomedical Sciences, she works as a medical imaging scientist leading the development of the next generation of ultrasound scanners, a safe and effective technique that could banish biopsies forever.

My name is Carolina Amador, I was born in Colombia where I did my high school and university undergraduate studies in Biomedical Engineering at the School of Engineers of Medellin in Colombia. During that time at University, I prepared to enter and join one of the great medical research institutions; the Mayo Clinic in Rochester Minnesota in United States of America, to one of its PhD programs in Biomedical Sciences.

In this process, I received a scholarship for the PhD. After five years, a lot of study, dedication and research, I obtained a PhD in Biomedical Sciences with an emphasis in medical images, in which I specialized in developing quantitative methods to diagnose pathologies in a non-invasive way using the ultrasound modality. My experience in the PhD was very integrative, from researching the application, developing the theory, implementing it in physical prototypes to be validated in the laboratory, to animal and real patient models.

Starting from there, I began another stage, specializing myself through postdocs, studies, and researches. In this phase, I generated new ideas and developed new inventions thanks to which I was able to acquire the title of Research Associate in the Ultrasound Laboratory and Assistant Professor in the department of Physiology and Biomedical Engineering within this prestigious institution. Currently I am a Scientist for the Research and Innovation department of ultrasound for Philips.

Carolina, tell us how was your research to diagnose and monitor liver fibrosis economically and non-invasively born and what is the philosophy behind it.

My research’s philosophy comes from when I was in the biomedical engineering program in Colombia. During my physics classes, I interfered with the biomedical approach and learned how to apply physics in it. In that process, I found out about the field of medical imaging and that is when I had my first contact with this beautiful area.

In the outer years of the program, one of the requirements to graduate was to take classes related with humanities, and an art interpretation course draw my attention. That is when my interest towards the medical imaging area increased, as I visualized it as an art, where medical imaging equipment manages to make art by using physical principles to build images of our body’s interior.

Then, I eventually graduated from university, and undertook my way to the Mayo Clinic, to a medical imaging laboratory where it literally is about making art with scientific knowledge.

It is in this place where my research got focused on the application of liver fibrosis began. All of it was born during my PhD study years, where my interest in making art with medical images took the direction of developing non-invasive methods to quantify the mechanical properties of tissues (such as elasticity for instance, a property that physicians used for centuries by means of palpation to detect diseases) and use these parameters as diagnostic supports that have an impact on today’s medicine.

The techniques I develop are based on ultrasound, a medical imaging modality that is low cost, fast, non-invasive and portable. I have participated from its technical development, laboratory validation using phantoms and animal models, to its implementation in clinical practice in applications where the standardized diagnosis method is biopsy; as clinical studies where, for example, its potential has been evaluated to diagnose chronic diseases of liver and kidney, monitor kidney transplants’ rejection, mammary inclusions’ and thyroid’s stratification.

The motivation to focus on the hepatic fibrosis case lies in my passion to develop biomedical solutions to real problems, and thus have a greater positive and contributory impact on society. Liver fibrosis affects 325 million people worldwide according to the World Health Organization and what I want is to help this population to obtain quick and concrete results for the improvement of global health.

What has it meant for you to be awarded by MIT as one of the 35 Latin American Innovators Under 35?

More than an honor to me, this recognition of MIT as one of the 35 Latin American Innovators is a challenge. First of all, the efforts, constant dedication, hard work, love and passion for what I do in the area of biomedical engineering, are highlighted and that flatters me. Secondly, it’s a challenge because it makes me responsible for carrying on with this passion, to keep giving my best and influencing the forefront of research and new generations. Finally, it is an opportunity as a woman in STEM (Science Technology Engineering and Math) to have a voice to communicate with the world. Advances in science and technology are not only the responsibility of scientists, we scientists need to have a voice to communicate with society and thus all contribute to our future.

How does the technique you’ve developed work and where does it stand?

As mentioned above, the technique I have developed is based on ultrasound, a medical imaging modality that is low cost, fast, non- invasive and portable, in applications where the standardized diagnosis method is biopsy.

Alternatives to biopsy focus on measuring the hepatic tissue’s elastic properties, elastographies. By measuring the wave propagation’s speed, it can be determined whether the tissue is soft or hard. As the liver becomes more fibrous, these elastic properties change, meaning that their noninvasive measurement may eliminate the need to perform biopsies to confirm the disease.

Currently, elastography is not a priority alternative for the hepatic fibrosis’ diagnosis because numerous clinical studies show inconsistency in elasticity measurements.
One of the reasons for these inconsistencies is that elastography does not take into account the wave frequency. Imagine when you throw a stone into the water quickly or slowly. My currently patented method is called recovery of fluence induced by the acoustic radiation force. Through experiments, I have verified that by measuring elasticity at various frequencies, accurate and consistent measurements are obtained.

With these excellent preliminary results, we are looking for collaboration between industries and academic centers, where with clinical studies, we will obtain successful results for elastography’s standardization to facilitate the hepatic fibrosis’ diagnosis and abolish cumbersome procedures for the patient in general.

Could it revolutionize success in the disease’s treatment and significantly increase the number of patients benefitting from it?

My advanced elastography method could revolutionize the treatment not only of hepatic fibrosis, but also of chronic diseases where the only quantitative measure is biopsy. Medical images are by nature qualitative and are tools that form a set for the doctor to diagnose the pathology. The revolution of elastography comes by its quantitative modality, offering a much more powerful tool in the diagnostic process. Besides this, elastography by means of ultrasound has the advantage of not being invasive, which makes it more approachable to society.

You are a woman and a biomedical engineer, what do you think is women’s role in the technological and scientific sectors in Latin America and, above all, what do you think has to change?

Historically speaking, we women have had less relevant presence in the area of science and technology. In 2017, according to the U.S. Department of Commerce, only 24% of STEM jobs belong to women. I have had direct experience with this situation, where day by day, in my work groups per every 5 men there is usually one woman. And if we take into account Latina and African-American women, this percentage can drop to less than 10%. For me personally, it fills me with strength and gratitude to be present there. I feel that I am leaving my mark, opening the way for new generations of women in the technological and scientific sectors, not only for our Latin America but also for all the women who struggle to get to these positions. Therefore, and because I am not the only one playing these important roles, our performance has been phenomenal and to admire as women.

What must change?
That we become more and more every day, that we fight for our right to be where we want to be and where we deserve to be because of our capabilities and abilities.

How can we do this?
Two simple steps: 1) by educating ourselves on inclusion and diversity topics and thus educate our professional networks, 2) by inspiring allies in this movement, let’s remember that every positive aspect counts and that to give support means to act for the cause.

You are currently working in the Philips Research Department in the United States. What moment of your career do you look back on most fondly?

The moment of my career that I see most affectionately are my years at the Mayo Clinic, especially the moments in which I actively participated in the international undergraduate, graduate and postdoctoral students’ educational processes. These people’s gratitude is immense, and I remember them with a lot of affection, because I learned so much from them and their processes have had an impact on my character and personality as a scientist.

I remember very well a student from Brazil who was doing research at the Ultrasound Laboratory at the Mayo Clinic, because I had met him before at a congress. He came up to me, without me knowing who he was, with an ear-to-ear smile, and said “you are Carolina Amador from the Mayo Clinic”. I was surprised and answered, “and how do you know?” And he said, “I study by reading your research articles, and seeing a Latin-American woman engineer in your position and doing science inspires me to move forward”.

In your opinion, what are the challenges faced in the immediate future by new technologies in the field of health and medicine?

There are several challenges, their dimension depends on the influential factors. One of the challenges for us who invent and implement new technologies is the lack of validation data. We call them “ground truth”, especially in the application of new technologies to pathological processes that are known in depth. The other major challenge comes from users, where the challenge is to change the routine and teach users over 30 years old to change their processes and accept new technologies.

What are your next goals and steps? Define the essence of your work and your research in one sentence.

In my transition from the Mayo Clinic to Philips – in other words, transition from doing science and research in the educational field to the industrial sector; I am discovering and facing new challenges in personal and professional aspects. As a consequence, these transitory challenges are what define my goals today. My current goal is to learn to do science in industry and to transfer technologies to real problems and products that have a social impact.

The next steps of my work go hand in hand with my goal, they include establishing and reinforcing my personal and professional networks, because in order to offer solutions to real problems, it is necessary to know what the real and current problems and solutions are. “It is time for scientists to learn how to communicate with the real world in order to provide solutions with great social impact.

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