A Smarter Image

Left to right: Dr. Tamatha Fenster and Dr. Bobak Mosadegh

Gynecologic surgeon Dr. Tamatha Fenster is a serial inventor who has advanced several prototypes, primarily in women’s health. One of her latest projects, smartHER MRI, allows for more accurate, 3D imaging of fibroids in the uterus, in collaboration with biomedical engineer Dr. Bobak Mosadegh, whose lab’s projects include work on real-time navigation systems for cardiac interventions and soft robotic cardiac stents, valves and pumps.

How your clinical experiences have inspired inventions.

Dr. Fenster: I think it is an obligation of every physician privileged to work in women’s health care to ask, “How can I make a difference and improve the care that I deliver on a daily basis?”

During my residency in 2008, I ran a special clinic for cervical cancer patients where we did electro-surgery to remove precancerous or abnormal cells in the cervix. The patient needs to remain still during this delicate procedure, and at the time, there was a high risk of injury to the vaginal sidewall if there was any movement. I redesigned Leep speculums, which are used for electrosurgical procedures, to provide 360-degree retraction of the vaginal walls to prevent burns. We garnered two patents and now have a product made out of silicone that has been used in patients for years. We’ve developed a safer technology; I’ve seen the actual benefit from that particular device.

Our smartHER MRI was inspired when I was in the operating room and realized that the patient’s conventional 2D imaging didn’t fully reflect the extent of fibroids in the uterus. What had appeared in the imaging to be an exophytic myoma, a fibroid that grows on the outside surface of the uterus, was, in fact, a broad ligament myoma, which is a much more complicated procedure and would require a different surgical approach. This experience made me crave a creation of a “4D” MRI image I could rotate in space to fully understand the relationship of myomas to other structures.

What your collaboration looks like.

Dr. Fenster: I met Bobak through a friend who was involved with life sciences entrepreneurship at Weill Cornell Medicine. I told her of my frustration with the imaging, and she knew Bobak had a solution.

We could not have a more contrasting skill set. I can tell you every clinical obstacle you’re going to encounter in the OR and say, “I think this would work.” And he can translate that into mathematical formulas and computer programs that can solve those challenges. He’s an incredible resource. Whether he likes it or not, he’s stuck with me forever.

Dr. Mosadegh: The feeling is reciprocal! We have complementary skills and abilities. But what keeps me and Tam engaged is that we both really love, respect and enjoy the process of innovation itself and innovating together. You cannot innovate in a vacuum. You have to bring together all kinds of expertise for an idea to translate into something real and practically useful. What really makes our collaboration effective is that if we have a random thought, or need anything, we just text each other. This makes it so easy.

Dr. Fenster: It’s also just so much fun.

Advantages of working in academia.

Dr. Fenster: If I had to hire a Bobak in the real world and say, “Can you iterate a thousand of these scans and train the model so that it automatically recognizes MRIs and translates to this 3D image, so that I can use it as a surgeon?” it would cost many tens of thousands of dollars. It would take years to get that money. By being part of this incredible academic center and resource, I’m able to tap into preexisting structures and use other people’s skills. And they use my skills, and things can move faster. SmartHER has been through two human studies. There’s no way I could have done that in private practice.

Dr. Mosadegh: As an engineer, the privilege of working in the medical school is working with surgeons, physicians and patients to identify the actual problem, and not what we think the problem is based on a few conversations. In academia, you can be focused on how to push the bounds of what’s possible. Also, being able to directly observe the invention in use and get feedback really accelerates the innovation process and ensures you’re solving a problem that needs a solution today.

AI and robotic technologies are democratizing processes that normally could only work in a startup or company. We have all the components needed to work on innovation in the medical schools. We have end users. We have patients. And we now have the technical means. We just need to synergize these resources and create.

What’s next for smartHER.

Dr. Mosadegh: We want to refine smartHER and push the bounds. We’re taking available imaging and presenting it more intuitively so patients and surgeons can best utilize it. We want to leverage AI to make predictive models and understand how to make better decisions about how procedures are done — or even which procedures should be done.

Dr. Fenster: I would love to see smartHer used eventually as a diagnostic tool to identify things that are very hard to see radiographically, like endometriosis or certain ovarian cancers. One wonderful result already is that there have been fewer cases of residual fibroids among patients whose surgeons employed this technology. That has incredible ramifications.