• Russell R. Lonser Presidential Address at the 2016 Congress of Neurological Surgeons Annual Meeting

    • Oct 28, 2016

    The Information Age: How technology and big data are driving critical changes in neurosurgery

    SCHAUMBURG, Ill., October 25, 2016 — How will the unprecedented expansion of data and technology affect neurosurgery? At the CNS Annual Meeting in San Diego, 2016 CNS President Dr. Russell Lonser delivered a compelling address on the future of neurosurgery in the Information Age. Using the Annual Meeting theme of advance, adapt achieve as a springboard, he laid out a thoughtful and compelling presentation on how technological advances that began with the Digital Revolution in the 1980s are now driving critical advances in data analytics, and how these will inevitably shape patient care in important and beneficial ways.

    At the outset, Lonser stated that the most potent influence currently affecting medicine is the rapidly expanding capability to acquire, store, process, and share data. These factors are at the core of where we are now, which can be called the Information Age. IBM Healthcare analytics estimates that individuals today will generate 100 gigabytes of medical data over their lifetime (the equivalent of 300 million books), and by 2020, the amount of medical data acquired in the United States alone will double every 73 days. At the same time, data storage capacity costs are dropping dramatically, while processing and analytics speeds are increasing. In 2001, it took nearly a decade to sequence the human genome and it cost nearly $100 million to sequence. Today, it takes only 26 hours and costs less than $1,000. Neurosurgery is inevitably changing as a result of information sharing, with patient data on the horizon to be universally connected, making patient care, medical education, and research accessible internationally.

    What does this mean for the specialty? Lonser stated unequivocally that today’s unprecedented data acquisition, storage, analysis, and sharing will fundamentally change and improve neurosurgery in clinical practice, education, and research. It is paramount that neurosurgery endeavors to exploit these changes successfully. 

    To illustrate how the Information Age will impact clinical practice, he presented a case example of a patient with glioblastoma. The patient underwent typical management procedures: gross total resection with mapping, standard radiation and chemotherapy, followed by serial MR-imaging for recurrence. However, in the near future, preoperative care will be significantly augmented by image data processing. Imaging repositories coupled with powerful analytic algorithms can determine genomic profiles, using standard MR-sequences, before the surgical treatment of tumors. The emerging field of “radiogenomics” will guide surgical treatment, improve prognostication and inform research. The accessibility and low-cost of complete tumor genome sequencing and detailed molecular analyses will dramatically increase their use and application. And big data analyses will define glioma clusters with distinct sequence, expression and methylation profiles, which in turn enrich tumor-specific drug targets for individualized treatments.

    Further, genomics and computer analytics are just beginning to be used to diagnose and treat patients. Less than three months ago, IBM’s Watson super computer was used to review and correctly identify a previously undiagnosed patient based on her tumor genomic data and medical records after analyzing the case for only 10 minutes. 

    Big data analytics from non-traditional sources are also being used to predict and identify complications and adverse drug reactions. For example, an individual’s internet search analyses (related to signs/symptoms found with various cancer types) could provide earlier detection of cancer by simply evaluating their search term history. 

    The Information Age will profoundly change education in neurosurgical residency and life-long learning in a manner similar to the concept of 3D anatomic teaching pioneered by Al Rhoton, MD. Today, emerging technologic and data advances allow 3D virtual reality case review for education and preoperative planning, and are being used in a handful (but growing) number of centers in the US. Another new technology, patient-specific 3D printed surgical simulation models, can now be made from patient images and are being used to evaluate various approaches on a variety of neurosurgical pathologies. This year, several medical schools are offering 3D holographic imaging to teach medical students normal and patient specific pathologic anatomy. Overall, these forward-thinking educational tools will help overcome limitations imposed by duty hour restrictions (which have negatively impacted resident hands-on experience and training), and will also enhance preoperative planning and approach assessment for neurosurgeons in practice. 

    Research will be radically different in the Information Age, moving from hypothesis-driven research to correlative science derived from large data analytics. Critical associations will be derived, frequently from big data analytics, before the biologic mechanisms are understood. Lonser urged physicians to become comfortable with correlation-based research for optimal patient management in the future, citing the story of the discovery of hand washing to prevent infection by Ignaz Semmelweis in the mid-1800s. 

    Several examples of new research paradigms include ORIEN (Oncology Research Information Exchange Network), where data (imaging, genomic, clinical and survival) is stored, shared and analyzed. The collective data is analyzed for prognostic, predictive and optimal treatment correlations.

    As a result of the processing/analytic speeds possible today, what would take months to analyze only a few years ago can now be done in a day. Combining the human brain connectome, which is providing unprecedented fiber tract detail, and complex physiologic data sets is rapidly providing biologic insights not previously possible. 

    But what is the likelihood, in the near future, that these changes will truly be adopted? Lonser provides historical insight: The adoption of television took 26 years, the adoption of the worldwide web took 7 years, the adoption of social media a mere 18 months. He urged neurosurgery to continue to lead in the transformation of healthcare in clinical practice, education and research. In clinical practice, by committing to innovations, building data-drive capabilities, and accelerating better outcomes through patient data and analytics. In education, by continuing to lead the development of emerging technologies that expand individualized patient simulation and preoperative technique assessment. And in research, by embracing big data-derived correlative science, but to validate those results and then exploit the findings to drive hypothesis-driven research. 

    Lonser presented an irrevocable case that current adoption of technological changes across medicine is advancing at a pace never seen before. And, as the specialty has done throughout history, neurosurgery will adapt to these changes in fundamental and positive ways, which will lead to achieving accelerated improvements in neurosurgical care, education and research that were not imaginable a short time ago.

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