ARTICLE: Medical Technology Is Boldly Going Where 'Star Trek' Has Gone Before
Bernadette Tansey, Chronicle Staff Writer

Monday, March 15, 2004

Like some wizard, Dr. "Bones" McCoy needed only to wave his tricorder sensor like a talisman over "Star Trek" crew
members to detect any ailment -- and to cure many of them.

In reality, McCoy's "sensor probe'' was a prop contrived from a salt shaker by a TV crew making do on the tight budget
of a fledgling series.

Cheesy props or not, "Star Trek's" futuristic sickbay tools presented a captivating vision of what medicine might one
day achieve, inspiring legions of fans who later became some of the world's most inventive scientists.

And in 2004, many of the high-tech instruments simulated on the "Star Trek" set are a reality, used to treat patients
in hospitals and clinics around the world.

Rather than undergo exploratory surgery, many patients now rest on tables similar to the Enterprise's sickbay bed while
an automated scanner delivers diagnostic images of the body's interior.

Blade-free "surgery'' is possible with equipment like the CyberKnife, developed at Stanford University. And devices
like McCoy's needle-free "hypospray'' injections are now commonplace vaccination tools.

Nothing close to today's non-invasive diagnostic tools existed when Gene Roddenberry conceived the "Star Trek" series
in 1964, according to British radiology professor Paul Goddard, who gave a talk in 2001 called "The Medicine of Star
Trek: Are we making it a reality?''

The field of radiology had been advancing slowly, and no body scanners of any kind were in clinical use, Goddard said.

But the past 40 years have seen the rise of an array of non-invasive scanning technologies like ultrasound, CAT scans,
PET scans and magnetic resonance imaging. MRI works by subjecting the body to a magnetic field and then detecting the
varying responses of different types of tissue.

"We're a little bit closer to what they show on 'Star Trek' 's sickbay,'' said Dr. Sanjiv Sam Gambhir, director of the
Molecular Imaging Program at Stanford. "We've got tools that are not quite at that level yet.''

Where imaging techniques in the 1960s could only outline basic internal anatomy -- an X-ray revealing a broken bone,
for example -- current technologies can also detect tissues with abnormal concentrations of blood vessels, or with a
speedier metabolic rate. Both are characteristics of cancer.

Beyond that, Gambhir said, researchers have discovered precise ways to scan for specific ailments like Alzheimer's or
Parkinson's disease and breast tumors linked to a genetic aberration. But unlike McCoy, doctors nowadays can't just
wave a sensor probe over the patient to use these disease-specific detection methods.

First they have to inject or feed the patient with a tailored molecular probe that can find the harmful protein or
abnormal gene connected with the disease. The probe then transmits a signal picked up by an MRI or other scanning
device.

Some of the new scanners are handheld units -- shades of the tricorder -- that can be used during surgery, Gambhir
said.

And others combine several different scanning methods -- an MRI plus a PET scan, for example -- to give a fuller
diagnostic picture. But Gambhir said we still don't have anything like the universal scanning device that allowed McCoy
to diagnose practically anything in seconds.

But Earth medicine is also moving closer to the noninvasive treatments available to McCoy, who considered the scalpel a
barbaric vestige of the remote past.

A form of blade-free surgery is now possible for certain illnesses. The CyberKnife, for example, uses a compact linear
accelerator to generate hundreds of radiation beams that precisely target a small tumor from different angles.

The rays are delivered by a 12-foot-tall robotic arm under the direction of a sophisticated computer guidance system.

CyberKnife systems, installed at about two dozen medical centers worldwide, have been used most often to destroy brain
tumors.

These tumors are easy for the robot arm to aim at because they remain in a fixed position relative to the bony
landmarks of the skull.

But doctors have also figured out how to use the CyberKnife on structures like the prostate that move around as the
patient breathes and digests food, said Dr. Christopher King, a professor of radiation oncology at the Stanford
University School of Medicine.

Physicians implant tiny gold particles in the solid tumor to give the automated CyberKnife fixed points of reference.

But King admits this slightly invasive technique might not pass muster with McCoy.

"We're nowhere near as far as it was in the TV series,'' he said. "There's always something that has to touch the
patient.''

The equivalent of McCoy's hypospray, however, is now a commercial reality.

More than a million patients received flu shots and other vaccines last year from needle-free injectors like those
manufactured by Bioject Medical Technologies Inc. of New Jersey.

Like the hypospray device, the company's Biojectors force a fine aerosol of medication under the skin or into the
muscles. The drug mist is propelled by a carbon dioxide cartridge.

But "Star Trek" was not the original inspiration for the development of needle-free injection, said Kurt Lynam,
Bioject's national sales manager.

The first pressure-driven injectors were produced in the 1940s in response to the U.S. military's need to rapidly
vaccinate thousands of troops during World War II and the drive by public health officials to eradicate diseases like
smallpox through mass vaccinations in the developing world.

But Lynam said those devices -- big, metal gun-style injectors -- were eventually suspected of spreading disease, and
their use was suspended in the 1980s.

Bioject's needle-free instrument, the Biojector, was introduced in 1994 - - part of a new wave of injectors designed to
eliminate past problems with the technology.

E-mail Bernadette Tansey at [log in to unmask]

SOURCE: San Francisco Chronicle Page E - 1
http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2004/03/15/BUGLV5J6GT1.DTL

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