Centre for Research in Image-Guided Therapeutics

The clinical research facility has created three distinct but conceptually linked centres, building on our strengths in brain sciences, cardiology and cancer. Innovations in image-guided therapeutics developed through preclinical and applied research elsewhere in the centre are tested in patient studies and clinical trials. This streamlined pathway accelerates the translation of discovery research into patient care.

This facility is accessible to all clinical researchers at Sunnybrook Research Institute. Shared space comprises patient exam rooms, space for data and sample storage, and a procedure room for image-guided interventions. Imaging systems for procedure planning and assessment, including MRI, computed tomography and ultrasound systems, are also linked to the facility.

Neurointervention centre

The clinical research facility has created three distinct but conceptually linked centres, building on our strengths in brain sciences, cardiology and cancer. Innovations in image-guided therapeutics developed through preclinical and applied research elsewhere in the centre are tested in patient studies and clinical trials. This streamlined pathway accelerates the translation of discovery research into patient care.

This facility is accessible to all clinical researchers at Sunnybrook Research Institute. Shared space comprises patient exam rooms, space for data and sample storage, and a procedure room for image-guided interventions. Imaging systems for procedure planning and assessment, including MRI, computed tomography and ultrasound systems, are also linked to the facility.

Minimally invasive electrophysiology & vascular procedures centre

In this centre, researchers are building on their success with the Imaging Research Centre for Cardiac Intervention (IRCCI) at Sunnybrook Research Institute. The IRCCI is a unique facility within Canada that brings an array of imaging technologies into a suite designed for patient studies. This helps us translate new technologies and techniques into the clinic faster. The new centre expands the IRCCI, and has increased our clinical trials capacity.

New studies are exploring the use of cell-based therapies developed by scientists in the Centre for Research for Image-Guided Therapeutics to repair the heart after a heart attack, and the use of electrophysiology guided by MRI to treat irregularly beating hearts.

In addition, there is a multimedia room used to train research fellows and to broadcast Sunnybrook Research Institute-pioneered procedures and techniques to remote sites.

This dual-site centre, which has mirror suites at Sunnybrook Research Institute (SRI) and Thunder Bay Regional Research Institute, is unique.

In it, clinicians, researchers and engineers, in partnership with the world’s leading medical device companies, are working together to develop and test magnetic resonance-guided focused ultrasound technology. This technology is based on the groundbreaking work of Dr. Kullervo Hynynen, director of Physical Sciences at SRI, and a Canada Research Chair in Imaging Systems and Image-Guided Therapy.

Magnetic resonance-guided focused ultrasound surgery will revolutionize medicine. One of its most potent applications is to destroy tumours noninvasively. It can be thought of as “scalpel-free surgery,” because no incision is required to remove the tumour.

It works by pairing MR with high-intensity focused ultrasound to a target within the body, like a tumour. The ultrasound energy is applied precisely to that spot, generating heat and destroying the tumour. During the treatment, feedback from MR functions as a thermal “map.” It is used first to identify the target, for treatment planning. It is then used to guide the ultrasound as it is applied. Finally, it used to determine right away if the treatment worked.

Scientists and clinicians are evaluating MR-guided focused ultrasound to treat uterine fibroids in a clinical trial. These fibroids are noncancerous tumours that affect up to 50% of women of childbearing age. Symptoms can be severe, and result in missed family and work time. Many treatments are invasive; a main one, hysterectomy, causes infertility. The MR-guided focused ultrasound treatment is an outpatient procedure that requires no general anesthetic. Patients go home the same day, and return to their routines quickly, even the next day. The technique was evaluated in 2015 by Health Quality Ontario as an effective and cost-saving intervention. Based on its analysis, the agency recommended focused ultrasound as a noninvasive option for women with uterine fibroids who want to avoid a hysterectomy. This recommendation is under review by the Ministry of Health and Long-Term Care.

Several other trials of high-intensity focused ultrasound are underway, including treatment of Parkinson’s disease, obsessive-compulsive disorder, and head and neck, and rectal cancer. In recognition of the pioneering work of our research and clinical teams, SRI was designated a Centre of Excellence in Focused Ultrasound. It is the first in Canada and one of only eleven in the world.

The preclinical testing facility at Sunnybrook Research Institute supports research across the Centre for Research in Image-Guided Therapeutics. It has a specialized suite for image-guided surgery and a biomedical imaging research suite. It is indispensable in speeding the translation of preclinical results to the patient’s bedside.

Image-guided surgery facility

This facility integrates essential preclinical imaging modalities, including MRI, ultrasound, X-ray and computed tomography, with state-of-the art surgery suites. Research teams are developing and optimizing minimally invasive procedures for musculoskeletal and cardiovascular surgery, and noninvasive imaging methods for brain, cardiac and cancer applications.

Few labs in the world are designed either for computer-assisted surgical musculoskeletal applications or to study large preclinical models of cardiovascular disease. This facility enables both, with some unique applications, like the integration of imaging for device guidance and targeted development of large preclinical models of occlusive vascular disease.

Moreover, it goes further, by combining different kinds of specialized imaging technology (like cone-beam computed tomography and 3-D ultrasound) to develop minimally invasive and more precise procedures. The aim here is to lower the risk associated with surgery, thereby resulting in better outcomes, fewer complications, shorter hospital stays and lower costs to the health care system.

Biomedical imaging research suite

There have been major advances in imaging technology over the last decade. Critical now is the translation of those lab-made results into clinical studies and ultimately to patients—the main focus of this imaging suite.

Equipment in this suite is state-of-the-art. It is enabling our scientists to develop new ways to see inside the body, to deliver therapy into the brain and body, and to monitor that therapy after it has been delivered, to evaluate how well it is working.

This facility is a core resource for scientists working on a variety of clinical challenges. One team is testing high-intensity focused ultrasound, a technology pioneered by SRI scientist Dr. Kullervo Hynynen, whereby focused ultrasound is delivered into the brain under MRI guidance to ablate lesions in the brain. Some of the applications have moved into clinical trials, including for Parkinson’s disease and obsessive-compulsive disorder, while researchers are working to optimize the technology for other conditions, like stroke. In 2016, Health Canada approved focused ultrasound brain surgery to treat essential tremor on the back of pivotal research from SRI and international sites.

Hynynen is also developing methods that use low-intensity focused ultrasound to disrupt the blood-brain barrier temporarily and safely. The disruption allows drugs and other therapeutic agents, like antibodies and gene therapy, to be delivered into the brain to a target area while sparing healthy tissue. This research will revolutionize the treatment of some of the most intractable diseases, including Alzheimer’s disease and brain cancer. In 2015, a Sunnybrook team was the first in the world to use focused ultrasound to open the blood-brain barrier to deliver chemotherapy into the brain of a woman with brain cancer. In 2017, Sunnybrook launched the world’s first trial to study the use of low-intensity focused ultrasound to treat people with Alzheimer’s disease.

Other researchers are using a 7T Bruker MRI scanner for preclinical and molecular MRI research. Projects include characterization of arterial and peripheral plaques to plan intravascular interventions; use of spectroscopy to assess neurometabolite concentrations; functional brain imaging in stroke and Alzheimer’s disease models; using MRI to detect early tumour changes that may indicate responsiveness to chemotherapy; MRI-guided focused ultrasound; and brain and spinal cord myelin imaging.

The translational research facility at Sunnybrook Research Institute has four state-of-the-art labs in which our scientists are developing new biological agents, vaccines and devices for image-guided interventions. The projects undertaken in these labs will transform our knowledge of medical biophysics—and then transform medical practice.

Molecular targeting and therapeutics laboratory

In this chemistry lab scientists are creating, purifying and validating molecules that can then be developed into imaging drugs and drug delivery systems, contrast agents that are used with imaging devices to see inside body structures and vaccines.



A main aim is to develop innovative approaches in which molecular “signatures” of disease can be detected and visualized. This will enable scientists to design new image-guided therapeutics, such as medical microbubbles and drug-coated nanostructures, that target these molecular signatures or pathways, and then track the effectiveness of the therapeutics once they have entered into the body.

Discoveries made in the lab may then move into our good manufacturing practice facility, which enables scientists to produce pure and safe biological agents that can be tested in patients.

This rapidly evolving field bridges the worlds of chemistry, biology and imaging, and has many potential applications in radiology, cardiology and neurology.

Cellular and molecular regeneration and repair laboratory

In this multifaceted lab, research teams are working to harness the regenerative potential of different types of stem cells toward developing stem-cell-based therapies and, where possible, visualizing how they work in the body under image guidance.

Clinically directed aims are to design strategies to repair damaged heart tissue and blood vessels; to rebuild immune systems that have been devastated by disease or the toxic effects of treatment; and to develop methods to be able to see these processes as they happen inside the body.

Learn about the GMP laboratory

Learn about the development laboratory

Sunnybrook Research Institute (SRI) has acquired a Medtronic O-arm and StealthStation surgical navigation system to develop minimally invasive procedures for musculoskeletal surgical applications. Together, they form a mobile surgical imaging platform for use in spine, orthopaedic and trauma-related surgeries.

“The O-arm, used in combination with the Stealth navigation system, allows us to navigate surgeries in real time based on intraoperative, conebeam CT [computed tomography] scans,” says Dr. Cari Whyne, director of the Holland Bone and Joint Research Program at SRI.

The O-arm’s donut-shaped CT scanner gantry (a movable frame that contains the X-ray tube and detectors) allows for simple, low-radiation, 2-D fluoroscopic images or full 3-D reconstructions in standard and high-definition resolution. The system’s digital flat-panel detector provides a large field of view, resulting in precise images of a patient’s skeletal anatomy.

The system, worth $1.6 million, is part of the preclinical testing facility within SRI’s Centre for Research in Image-Guided Therapeutics. Whyne will use the equipment in her research on photodynamic therapy for cancer that has spread to the spine. The therapy combines a light-sensitive drug with a locally applied light delivered via a laser fibre inside a small tube called a cannula. When the drug is taken up in the tumour and a light from the laser is turned on, the cancerous cells die.

“The O-arm allows us to visualize exactly where that cannula is placed, so we can ensure optimal treatment delivery intraoperatively,” says Whyne.

Currently located in the hospital’s musculoskeletal operating room on the second floor of M wing, the system will eventually be housed in the preclinical testing facility in S wing, set for completion next spring.

The purchase of the O-arm surgical imaging system was made possible by a $57-million infrastructure grant from the Canada Foundation for Innovation through its Research Hospital Fund.