Jim Cooper's Orange County; Brain Imaging at UCI

This machine that the UCI Medical science building is called a positron emission tomography scanner. Its short name is a PET scanner. It cost a hundred thousand dollars and is the only such machine in a department of psychiatry anywhere in the world where the research teams at the UCI Medical School department of psychiatry it is revealing startling new information on the human brain. The volunteer subject for this simulated CAT scan of his brain is Maurice park of

Westminster a government contract administrator whose brain is perfectly normal. He will understand the process because he was the good citizen who first volunteered for an actual PET scan at the UCI Medical science building. He will have thirty two electrodes fastened to his head to record the electrical activity of every part of his brain. This is a separate type of brain imaging but it's done simultaneously with a radioactive PET scan the PET scan process is based on the simple biological fact that the brain needs sugar for its energy. The PET scan utilizes and injection into the patient. I have a solution a radioactive sugar glucose particles tagged with radioactive isotopes. This radioactive solution is prepared in the cyclotron at UC Davis in Sacramento and then flown to UCI for each pet scan procedure. The most actively functioning part of the brain uses the most radioactive sugar for its energy. This extra activity shows up through the PET scanner as a computerized image of the thinking living brain on a computer

screen during the brain imaging session after the electrodes are on place the patient lies down to await the placement of I.V. tubes in his arms for the injection of isotopes and for blood samples. Dr. Moneybox Bohm M.D. professor of psychiatry at UC Irvine has used images of his own brain to develop the PET scan while at the National Institute of Mental Health in Washington. He explains what happens next. The isotope had just arrived from the University of California Davis where it was produced and they were cyclotron it comes in this very heavy lead container. And I'm going to take out the sample. The floor of the oxy glucose and first measure the level of radioactivity in the counter. After I done that I know how big a dose I'm going to administer to the subject.

And I'm going to withdraw the radioactive sugar for the first subject that we're studying today. Here is the dose that's ready and then I'll put the radioactive sugar back in its lead container and save it for the second patient. Now we're ready to inject our patients in the other room. Volunteer Maurice park is now sitting in the testing room. He has I.V. tubes fitted into his right arm for the radioactive injection. Then in his left arm where blood samples can be taken during the scan procedure the. First doctor about spam comes in and gives him the injection of the radioactive isotope and glucose solution.

After that the brain must be tested and Mr. Park then goes to work thinking. The thinking part of the brain will be shown most vividly on the computer screen. Now Mr. Clark you're going to be seeing a series of slides and I want you to test them that you're right. I think you're. Right. The volunteer must now watch a small video screen where he might detect rapidly flashed numerals. He is given a control handle with a button to flash the numbers and attempts to recognize them in a fraction of a second. As he strives to recognise the number. That part of the brain uses more energy and will be detected exactly on the scanner. Following the metal casting. He comes into the scan room and is immediately placed on the table to be put into the scanner. A white Styrofoam head mask has been cut out to fit his head. This is to make the patient more comfortable and to keep the head from moving. There is no pain or discomfort during the

testing. Controlled on the table. Well move the head forward a fraction of an inch into the center at intervals thereby displaying the entire brain in cross sections on the screen. When the test begins Dr. Buck's crime works at a computer console while through a window he can see the patient on the table as a test continues. He can move the patient forward into the scanner examining every portion of the living brain. The screen do its computerized scanner can examine functioning of the normal brain activity to learn how this amazing organ of the body works. But it can also examine those with mental illness to learn more about treatment. Dr. bucks you yourself about a subject on the PET scanner is there any harm I think of the first question people would like to know to the subject whether is a dose of radioactivity. But it's a very small dose. It's about a tenth of what is allowed to nuclear medicine workers who are doing brain scans in a three month period of the year. This is the level the federal government has sat as being absolutely non harmful. So we're

really dealing with very low levels of radiation and that's why such a large and expensive machine is required. The technology here is most impressive but what does it really mean in medicine for. Research into the brain. Well there are two main directions in which this research is going. The first is with the use of the sugar radioactive isotope. We're able to really see what areas of the brain are involved in thinking and feeling. So for instance as you were are interviewing me we would give you the radioactive isotope and these areas on the left side or right side or whatever part of your brain you use to ask personalities questions we could see what areas of the brain would be active and this way of understanding human function will give us hints about education about learning disorders and about just the interesting aspect of how the. Brain thinks. What we see on the computer is the brain of Metropark Can you explain what that means. Yes you remember in the other room Mr Park was watching a series of slides while the

isotope was injected. This part of the brain shows a high level of activity. This is the part of the brain the visual cortex where the image material comes in from the eyes to areas of the brain used to understand pictures. This is the area that Mr. Park is using to solve the problem and press the button in response to the slides. Professionals say that more has been learned about the human brain in the past 20 years than in all the sum of human history. Watching the awesome creation of nature that is the human brain while it is engaged in thought promises to open even more doors of knowledge and to gain much in the fight on mental illness. And I have that very extraordinary unusual trip for a PET scan. But meet our special guest Dr. William Bonney M.D. is professor and chairman of the Department of Psychiatry College of Medicine at UC Irvine. He's also a professor of pharmacology and psycho biology under his direction the UCI College of Medicine is becoming one of the world's most advanced

imaging and research centers for the brain. Dr. Steven Popkin the M.D. is a professor of psychiatry and director of research and clinical adult treatment laboratories with the UCI College of Medicine. He was formally acting chief of the Center for Studies of schizophrenia National Institute of Mental Health and he was the first U.S. exchange scientists between the people's will Republic of China and USA. Dr. Richard hire psychologist as Associate Professor Department psychiatry and human behavior at UC Irvine. He was previously an assistant professor in the section of psychiatry and human behavior at Brown University. He is now involved in the UCI brain imaging facility. Well gentlemen in the current series about the brain on PBS they have made this startling statement to me that in the past 20 years we've learned more about the brain this this part of the anatomy than the sum total of all of history prior to this. Do you have any theory on why this area of medicine seems to be going through such an accelerated burst of information. Dr. Bonnie let's start with you.

Well Jim I think it's it's clearly a reflection of the explosion of information in the basic sciences. And neuroanatomy in biochemistry molecular biology there is literally I think explosion is the right word. Tremendous basis now of information. And we've been able to build upon that and to learn about the human brain to have gone through this experience that I did as a layperson to come out there and come to grips with this with an extremely exciting episode in my life watching where we are now with medicine. How would you answer the question about why this sudden this sudden burst or explosion of knowledge about the brain. I think the explosion that's happened because people across disciplines. And so that you know basic scientists from various areas were able to really look at how the brain functions. And the advantage of this explosion now is that we're at the point where we can really begin to understand how the brain works. And before we were able to get

close enough we were too far away but because of the advances are right at the edge of being able to discover the basic mechanisms and the basic mechanisms are the ones that really allow us to take a step forward like finding an iron lung doesn't really help polio. Well if you figure out that it's caused by a virus then you can really take a giant step forward in understanding traveling right with psychiatry certainly a psychology in the study. And that there's always been a dichotomy in psychology as to whether people behave the way they do because of. Other influences such as behavioral influences or do they behave the way they do because of chemical differences. Read about psychology in this explosion. Well right along with the advances in brain research in Biological Psychiatry particularly a lot of new information indicates that relatively normal behavior every day behavior every day personality is also very influenced by the brain and individual differences in the way the brain works.

I would say also that one of the reasons research on the brain went relatively slowly for such a long period time is because the brain was run hard to get to compared to other organs in the body it was very difficult to study without disturbing it to the point of injuring a person. And secondly the brain unlike most other organs of the body is not uniform tissue so that your liver is your liver whether you sample it over here over there I see yes but the brain is vastly different from one portion to the other portion with very specialized functions extremely specialized. The thing I was impressed with also is that when you do the PET scan. If you take a mosaic approach in that you have easy but other ways to image the brain such as the electroencephalogram Nuclear Magnetic Resonance am and i'm are. Beside the PET scan and the CAT scan or computerized axial to

my coffee. What is the purpose of this effect. This month I approach on imaging Dr. Bell. This is this is really a major potential advance here. This hasn't all been put together at the present time but as you see we now have our PET scanner and Doctor hires an expert in topographical map into the brain with EEG. And Dr. Frieden bird head of the department of Radiology has developed developing an M.R. which gives you a very accurate anatomical picture. I see all of the brain third dimensional just like knowledge cannot know but it can give you different images of the brain and you can then put these together and it has an immense potential of integrating information which has not been available evidence at all that good what I like to pick up that on that integrated attack on the problem.

Does that mean then that one area of research of imaging reinforces Another is that the idea that you get a mosaic I get to be a good word to use. You get a mosaic of the human brain and more about this organ than has ever been known before. We like to illustrate this by giving the following example. If we have a patient and we take a CAT scan of that patient's brain and then we take a PET scan of the same patient first we can look at the CAT scan and we can see all the internal structures of the brain very clearly and very accurately and then we can look at the PET scan of the same patient. And in this particular case suppose the PET scan is absolutely great and shows no sugar metabolism at all. The question is what's the diagnosis of the patient. The answer is patients dead. And the point is you can't tell whether your patient is alive or dead Yes just from a CAT scan. So the brain works on many different levels electrical bio chemical structural and you need a different technique to get it. Each one of these rivals and if you can do all the techniques simultaneously then you can get a

multifaceted view of the brain and how all the different levels that they relate to which I mean to the point about the PET scan is it gives you functioning of the brain. That's what's so unique and so exciting about it. And that's along in medicine and medicine through the centuries has had to deal with study of cadavers study of dead tissue. This is the study of the living brain. Right. Yeah. Dr BUCK BROWN I was talking to him said it. He said I could see two immediate advantages the first one of what he alluded to there was to look at the functioning living brain for a diagnosis but the second one he said is to see how that brain reacts when it has medications such as the medicine to control schizophrenia as opposed to when the brain does not have that medicine. Radical differences dramatic differences. Do you want to comment a little bit on that and where this can lead to direct application to patients. Well for example in schizophrenia which is a devastating illness that many patients with schizophrenia have been shown to have decreased glucose metabolism in the frontal part of their

brain which has to do with thinking and feeling. And when given medication that seems to help the patient they no longer have this abnormal metabolism in the front part of their brain. So this is a way to figure out how the medication works. And that excuse me can but then conversely when they get the medicine then the metabolism seems to increase again. Yes it goes back towards normal it tends to get more normal. And the advantage of this is that one can target what is the abnormality in schizo phrenic brain and then design creative new medications to try and target that particular area. Are we on the threshold of that kind of direct application or is it a little too soon. Oh absolutely on the threshold of it we haven't quite gotten there but we are on the threshold. We're about to cross into that. What we have now is the ability to study how the brain functions. Yeah we know how we can study special medications to see how they work. We have just a few more steps to put the two things together to see how we can improve treatments for patients who want

an exciting absolutely exciting and extraordinary area of research or are you working on a threshold of it. I'm going to I think that tied into my next question for Dr. Ronnie. You have a dream and I'm going to express the words of the dream. They would be called the International Institute of brain and behavior tell us about your dream. Well I think in order to tell you about the dream I have to take a minute to tell you about what the problem is. Just to review it. The problem is that mental health is a major problem in this country. There are about 2 million schizophrenia cks about 10 million people suffering from depression. There are a large number of alcoholics a large number of drug abusers. Twenty five thousand people commit suicide every year in this country. And that's the problem and the question is what to do about it. Now part of what you do about it is you use the best diagnosis and the best treatment you have at the present time. But the only ultimate hope is research because

you want to know what the causes of these illnesses are. And so our dream is to build a clinical research center here which we have called which we will call the International Institute on brain behavior and it will have a group of complements or have a center on depression one on schizophrenia one on childhood mental illness one on mental illness in the aged one on alcoholism and drug abuse and one com point of that will be a center on brain imaging which will tie into all the rest and facilitate the research in the other compound that's up it will also have an international component which Dr. Popkin is director of. And that will lead international studies throughout the world which in fact we're currently doing arson. We were just wrecked just approved as the Center for Biological

Psychiatry and training for the World Health Organization in the United States. How fast now and that will be part of this international institute. I notice that the word international That seems to be one of the governing words there because there's this cross-fertilization this idea of a matrix of information of a mosaic of information. Does that mean that you would then have this kind of cross-fertilization with the best brain research in all the countries of the world. That's one of the ideas that's one of the basic and clinical research. We'll have a hospital associated with this which will be an outstanding resource for Orange County in Southern California. Let me read a quote because it bears into what you're talking about this business of a mother I disciplinary attack on the problem. From an article that you wrote in psych treat psychiatric analysts along with Dr. Buck's bomb and Brian Garland I quote PET scan technology is a fascinating combination of several scientific disciplines including physics computer science neurology radiology fine ecology biochemistry

psychiatry and mathematics that is one mouthful of disciplines. Right. Do you envision all the disciplines being embodied in this international. It's to the brain and behavior. Absolutely in fact we already have an expertise in these in order to do the PET scan at the present time. And what about the clinical end of it where you actually see patients and you're seeing patients all the time and your job. Question How would you how would you tie in with this seeing patients applying that kind of knowledge to a practical application. Well psychiatry has really been limited and terms of using just a clinical interview in order to understand what's wrong with patients. And now for the first time we're able to understand how the brain of those patients works and the promise is by understanding the brain directly rather than so indirectly that we'll be able to offer brand new treatments so that the idea would be that patients that would come to our center could be diagnosed clinically and that would also have

access to this technology so that we could study their brain functioning and then we could see based on the brain functioning well be the most appropriate treatment and then go forward from that to use the best treatment possible so this will help the patient in a way that we couldn't do any other way. We tend to target our treatment that lead to another very practical pragmatic question. It's one thing to have the dream of all of these expansions. The other is to have the financial wherewithal. So I'd like to talk to you a little bit about the practical side the logistics Maybe Doctor how you want to start with some comments and I know you have the Nelson building going in which it perhaps the precursor of other such partnership with private industry. Yes I think Dr. Bonnie can talk about the Nelson building but the logistics of the PET scan are absolutely nightmarish. You show day in at the top of the program. The second part of our PET scan day that is from the patient's point of view. Yes before we even get to that part we have to

manufacture the radioactive isotope and that starts early Wednesday morning and that's done up at UC Davis and it's ready about noon. We have to fly a private plane up to Davis. It's at the airport. The isotope is brought over the private plane flies down here arrives about 3:00 o'clock at John Wayne Airport. We then drive the isotope over to our lab where the patient is ready. This is not only complicated it's even very expensive and that's why we can only run our PET scanner One afternoon a week. So we spend one afternoon a week doing science with brain imaging and the rest of our time we spend writing grants for the money to pay for that one after the grant grant proposals or grant proposals right. Bottom line is not in need of money to support this program and to develop our international institute. Let's talk about I mean we mentioned we alluded to the Nelson Bill you tell us about that because I think I see that as a precursor for other advances a private industry working in partnership with the university for

research. This is an exciting development. I had a role in this but what we were now doing is we've developed the first agreement between private industry the University of California and I this is Nelson research. And they're they're developing their corporate headquarters on the campus there. And about a half of the space will be used by the university pharmacology doctor Steins Department and the other half will be used by the other quarter and will be used by the Department of Psychiatry for the brain imaging center. Let's dream a little bit further. What kind of approach what kind of appeal would you say to any industry that might be interested in this program. What kind of an appeal would you make to them and how it would be simple good business for them to get involved with research with the university with dollars. While I think this is a broader thing than Department of Psychiatry and broader than the medical school I think there are

many areas of really exciting developments in the university particularly now under the leadership of chance the partisan and the leadership of the medical school to invent an ark in which we are continually of facilitating interactions between industry and the university. There is high tech There is exciting developments in research and this is very attractive to industry in terms of developing collaboration and I see it not as something that would be altruistic only or charity only but would be pragmatic good business for industries to get in on this. Tapped a source of information. Absolutely absolutely good business. Particularly in getting a cyclotron here at it. You see I know you mentioned having to take a for example a cyclotron having to bring it all the way down from Sacramento. Is there something that is a part of your dream for the cyclotron. Well we're trying to raise money right now to buy a cyclotron there commercially

available we have the space to put it. We have the people to run it. We just need to raise the money to buy one and that would allow us to run five days a week instead of one afternoon it would be many applications of cyclotron not just the department I think when I actually got to the research that we're trying to do it could also be an offer industry is that true. Absolutely. That is are at some kind of a profile that you would ask where the back Dr pockets or any special kind of a profile that would make a good volunteer for a PET scan. Sure. Right now we have some long going studies for patients that suffer from anxiety and in the future we're planning some studies on patients with schizophrenia. So right now we're ready. We're right now we're actually measuring the brain metabolism and patients that suffer from anxiety and we need more and we need more volunteers. That might be suffering from anxiety disorder. I'm just thinking about right Leslie this program now might be some other physicians whose patients might be a clickable to this or some people who have perfectly normal behavior but still are willing to volunteer you looking for that kind like like Mr. Market but are always looking for more normal volunteers we have a backlog of many right now.

Our main interest is getting patients with anxiety disorders higher with high anxiety levels right patients with high anxiety levels and who who with and who who lied to you. Here the number for the call. The brain imaging center called the brain imaging center at UCI 7 1 4 8 5 6 4 2 4 4 Let me give that number again that the brain imaging center UCI 8 5 6 4 2 4 4 and call up and get the information there's no there's no obligation is there for anyone calling to get it get the information. Not at all. All right how are we doing now. Our Way I see our time is almost up to very quickly. What's your best dream for the future and and psychiatry best dream for the future. Discover some of the causes of some of these illnesses because you not only have an effect on the people suffering now you have you prevented in the future that that's the ultimate dream. Oh and how about ranching in the future. Prevention in the future. And where are your immediate dreams over the next few months is to get a cyclotron down that the media can get a

cyclotron. Thank you very much for our time is almost up now and I want to thank my guest today for their quest for more knowledge than the front here of the human brain. Please join me on Friday December 14th at the same time when all examine the future water needs for Orange County. I'm Jim Cooper. Thanks for being with us.