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Mark Brezinski, MD, PhD, admits to skipping his share of resident lectures when he was a Cardiology fellow at Massachusetts General Hospital. Fellows weren’t required to attend, after all. But his attendance at one particular lecture in a small conference room on one of the patient floors has led to pioneering work in the development of the optical coherence tomography (OCT) field and groundbreaking discoveries that extend to cardiology, orthopedics and other areas of medicine.
“In this residents’ lecture, we learned that no available form of imaging had resolution high enough to detect heart attack-causing plaque,” said Brezinski, who is now the director of the Optical Coherence Tomography Laboratory in BWH’s Department of Orthopedic Surgery. “And being able to detect this type of plaque is critical in preventing a heart attack.”
The few sentences the then-chief of cardiology had spoken on the topic resonated with Brezinski, who immediately began thinking about solutions. “It was really challenging in the beginning because we had no resources or funding,” he said.
In 1993, he was attending an American Heart Association conference in Atlanta, when his research began to make sense. Seated at a restaurant table, he drew out his concept for optical coherence tomography on a paper napkin.
The catheter-based invasive imaging system would provide high resolution imaging because it was based on light, rather than ultrasound.
His first attempt at developing the imaging technology followed later that year, and in 1996, he published a study in collaboration with several other researchers in Circulation demonstrating the first successful use of OCT in nontransparent tissue. Prior to this, the technology was only capable of capturing images of the transparent retina. In the same paper, the researchers discovered the ability of OCT to identify vulnerable plaque, a type of plaque that causes heart attacks.
OCT may help in diagnosing diseases earlier and more accurately, with up to 25 times higher resolution than any other technology available for clinical medicine. It has a high video rate and small catheter size (equivalent in diameter to a hair strand), and the ability to be combined with spectroscopy. It has the magnification of a biopsy, but obtains 120 of them a second. OCT produces high-resolution images of coronary arteries and stents so that physicians can look at never-before-seen details inside patients’ blood vessels.
After a decade of work that began in 1994, the technology is used in clinical trials with a wide range of medical applications and is being commercialized in cardiology by St. Jude Medical. The technology released in 2010 is now sold in 37 countries and used in many hospitals, including BWH. It is also the source of many U.S. jobs.
Brezinski is working to identify other areas of medicine where OCT could have a powerful impact. Currently, he is focused on preventing degenerative arthritis as well as other orthopedics diseases, working closely with BWH sports medicine surgeon Scott Martin, MD.
“Now that people are living longer, we want them to live healthier,” Brezinski said, citing the technology’s potential impact on disease prevention, particularly joint deterioration.
In June, he published an editorial in Circulation, focusing on two recent studies of optical coherence tomography and its impact on cardiovascular disease. “As someone in the field since the original paper describing its utility, I think OCT has great potential to be high impact technology in managing cardiovascular disease,” he wrote.