USF Health researchers have launched several clinical trials as part of the world-wide effort to reduce the severity and even prevent COVID-19.

In connection with Tampa General Hospital, the USF Health researchers are leading the examination of a range of medications and treatment protocols that could impact the disease at a symptoms-level for patients and at the cellular level of the virus.

“The USF Health Office of Clinical Research and supporting parties are making strides that we’ve never made before,” said Rachel Karlnoski PhD, CHRC, director of Clinical Research Operations for USF Health.

“The typical start-up timeframe for new clinical trials in an academic medical center is 90 days or more. Our goal for COVID-19 trials was five days or less and we have succeeded. Communication, collaboration and prioritization from our budget and contract analysts, onsite legal counsel, USF IRB, central IRBs, investigators, study teams and regulatory manager have enabled our success.”

The united, expedited efforts paid off and now USF Health and TGH are conducting multiple front-line studies that link to larger efforts across the country, all in sync for finding treatments and cures for COVID-19.

“I am humbled by the response from our MCOM research staff, and their willingness to volunteer and put themselves at risk,” Karlnoski said. “We have over 30 volunteers from all departments comprised of nurses, coordinators, regulatory specialists, and data analysts who are ready to be deployed when a COVID trial becomes available. The silver lining behind the pandemic is the visibility it has brought to the importance of clinical research in the advancement of medicine. I am optimistic that we will find an effective treatment.”

One of the main overarching research efforts is the inclusion of data related to COVID-19 as part of a national registry tracking many aspects of the virus and those infected with it, such as pregnant women and their babies. USF Health and TGH providers are actively submitting information to this registry.

Among the clinical trials being set up or currently underway are:

• Testing sarilumab to determine effectiveness in blocking inflammation in the lungs in hospitalized severely ill patients.
• Two studies, one in adults and the other in children, are looking at the emergency use of remdesivir, an antiviral drug that may help kill the virus. These studies are for critically ill COVID-19 patients.
• Several studies looking at hydroxychloroquine, on three main fronts:
  • For severely ill patients: Given to patients coming into the emergency department who are severely ill and are going to be hospitalized.
  • For health care workers: A multi-site clinical trial involving 15,000 health care workers across the country to determine if hydroxychloroquine can prevent COVID-19.
  • For outpatient use: Given to those who test positive for COVID-19 but are not severely ill and don’t need to be hospitalized.
• Using convalescent sera/plasma from people who have recovered from COVID-19 in those who currently have the disease to test the sera’s ability treat these COVID-19.
• Testing 3D printed nasal swabs to confirm their ability to prevent so many false negatives compared with standard swabs when used for testing for COVID-19.
• Testing in outpatient settings the use of inhaled nitric oxide to help treat patients with COVID-19 who require supplemental oxygen.
• Studying Ruxolitinib in critically ill patients with COVID-19 and the impact of the medication in easing or stopping the associated cytokine storm, when the patient’s immune system becomes overwhelmed and attacks healthy cells.
• Other studies are looking into ways for treating pneumonia associated with so many cases of patients with COVID-19; assessing the safety and anti-coronavirus response of combined suppression of host nucleotide synthesis in hospitalized adults with COVID-19; testing Brequinar, an antiviral drug for treating COVID-19.

For more information about these and other clinical research taking place at USF Health, please email the Office of Clinical Research at ocr@usf.edu

TAMPA, FL, SOMERVILLE, MA, and NEW HYDE PARK, NY – March 28, 2020 – The University of South Florida (USF) Health, Formlabs, a leading 3D printing company, and Northwell Health, New York’s largest healthcare provider, today announced they have successfully produced and tested a 3D printed nasal swab to address emergency shortages that hospitals and health care teams may face as testing for COVID-19 increases.

Key milestones in testing the swabs were conducted by USF Health faculty researchers in the Departments of Radiology and Infectious Diseases in collaboration with Northwell Health, including validation testing (24-hour, 3-day, and leeching), and rapid clinical testing at Northwell Health and Tampa General Hospital. All testing showed that the 3D printed nasal swabs perform equally to standard swabs used for testing for COVID-19.

After identifying that nasal swabs for testing COVID-19 were in high demand and extremely limited in supply, a team from the USF Health’s 3D Clinical Applications Division created an initial design, working with Northwell Health and collaborating with Formlabs to develop prototypes and secure materials for a 3D printed alternative. Over the span of one week, the teams worked together to develop a nasal swab prototype and test it in the USF Health and Northwell Health labs. In two days, USF Health and Northwell Health, using Formlabs’ 3D printers and biocompatible, autoclavable resins, developed prototypes. The swabs were tested by clinicians at Northwell Health, USF Health and Tampa General Hospital for patient safety and comfort. Now that clinical validation is complete, 3D printers at USF Health and Northwell Health will produce the swabs and provide them to their patients.

“This is a prime example of the incredible impact we can have on human lives when teams of experts across academia, health care delivery, and the tech industry come together,” said Charles J. Lockwood, MD, MHCM, senior vice president for USF Health and dean of the USF Health Morsani College of Medicine. “During this current COVID-19 outbreak, there is little time for delay, and the swift, agile and adept action of everyone on this effort will greatly improve this nation’s ability to test patients.”

Summer Decker, PhD, directs the 3D Clinical Applications Division in the USF Health Morsani College of Medicine and has been at the forefront of USF Health Radiology’s department trailblazing use of 3D modeling in clinical capacities.

“When we were notified of the shortage of swabs by Dr. Lockwood, we immediately began working as a team to create a novel design in a printed material that was proven safe for patients, as is Formlabs’ surgical grade resin,” said Summer Decker, PhD, associate professor in the USF Health Morsani College of Medicine and director for 3D Clinical Applications in USF Health’s Department of Radiology. “We reached out to Northwell Health and Formlabs to work with us on this response initiative. With our collaborators in USF Health Infectious Diseases, we’ve been able to validate the printed swabs utility for this purpose and are extremely optimistic about the pending clinical testing results. With 3D printed swabs, we will be able to add thousands of swabs a day to testing kits developed here at USF Health, and treat more patients safely and effectively. We look forward to continuing to work with Northwell Health and Formlabs to further combat the COVID-19 pandemic.”

In addition to Drs. Lockwood and Decker, faculty from across USF joined in the design and creation of the 3D printed nasal swabs, including: Jonathan Ford, PhD, Todd Hazelton, MD, Gilberto Jaimes, Howard Kaplan, Kami Kim, MD, John Sinnott, MD, Michael Teng, PhD.

Jonathan Ford, PhD, a biomedical engineer in the USF Health 3D Lab, pulls newly printed nasal swabs made of specialized clinical/surgical material and ready to be used for testing for COVID-19.

“Northwell Health is proud to collaborate with Formlabs and USF to address the global health crisis of COVID-19,” said Todd Goldstein, PhD, Director of Northwell Health 3D Design and Innovation. “When we saw that the testing kits were limited in supply, our 3D printing lab immediately changed focus from creating materials for surgeries to designing and creating materials that help our front-line healthcare providers treating COVID-19 patients. In one weekend, we worked together to develop a nasal swab prototype and test it in the lab. After our positive testing results, we then immediately went to work and have already started producing 1,000-1,500 swabs per day. Not only will these swabs be provided to Northwell Health patients, we are also proud to be sharing the design with other institutions that can 3D print so that patients across the country can benefit from our work.”

Formlabs’ CEO and co-founder, Max Lobovsky, said: “Formlabs has been working around the clock to provide assistance in the wake of the COVID-19 pandemic, and we’re hopeful that our efforts will help patients get the care they need. It is important that the medical devices we supply to medical professionals on the frontlines battling this disease are safe and work effectively so as not to put workers or their patients at risk. By working hand-in-hand with Northwell Health and USF Health to design and safely produce these swabs, Formlabs is providing a viable solution to the current shortage of nasopharyngeal (NP) swabs and can now produce them at scale to help hospitals better treat patients.”

“During this unprecedented time, Tampa General Hospital is proud to unite with USF Health, Formlabs and Northwell Health to ultimately help save lives. I’ve been humbled and inspired by the perseverance, sacrifice and teamwork of our clinical teams collaborating to create the 3D printed nasal swabs to test patients in need, during emergency shortage situations. Thank you to Formlabs 3D printers for being a true partner to all of our physicians and teams working tirelessly to protect the health and safety of our community and beyond,” said John Couris, president & CEO of Tampa General Hospital.

It is worth noting that the “FDA believes that a nasopharyngeal specimen is the preferred choice for swab-based SARS-CoV-2 testing,” and that “collection should be conducted with a sterile swab.” With years of experience in the medical industry and hundreds of hospitals already using its technology to develop tools for surgery on-premises, Formlabs adheres to a wide range of required sterilization, regulatory, safety, biocompatibility, and manufacturing standards. The company produces sterilizable, surgical-grade plastics for use in medical and dental applications, and its FDA-registered manufacturing site has an ISO 13485 certification. By turning to proven 3D printing technology to improve production processes, shorten supply chains and localize manufacturing, healthcare providers can quickly and efficiently gain better access to the supplies they need to combat COVID-19.

Photos and video by Allison Long, USF Health Communications.

Using data specific to each patient, 3D models of bone and organs can be created to guide surgeons and educate patients.

Cardiologist Fadi Matar, MD, holds a model of a heart in his hand, studying the route he will take to insert wiring into his patient during surgery.

The model is not a generic, one-size-fits-all example of a heart using average measurements. This heart model is built using the exact measurements of that patient’s own heart.

This specific, anatomically correct heart model was created using 3D printing and a complicated algorithm that combines data from ultrasound, CT, and MRI scans for that patient. This heart – along with other organs and bone structures – is from the USF Health Department of Radiology, built by printers housed in one of USF Health’s flagship clinical facilities, the South Tampa Center for Advanced Healthcare.

Summer Decker, PhD, an imaging scientist, and Jonathan Ford, PhD, a biomedical engineer, are the two-member team creating the organ and bone models that are altering both medical care and standard approaches to surgical planning.

Dr. Summer Decker (left) and Dr. Jonathan Ford make a 3D model of a heart in USF Health’s Department of Radiology in USF Health South Tampa Center for Advanced Healthcare in downtown Tampa. Dr. Decker, the director of imaging research, and Dr. Ford, a biomedical engineer for imaging research, have been at the forefront of USF Health Radiology’s department trailblazing use of 3D modeling in clinical capacities.

“I have surgeons tell me they won’t even think about starting surgery without one of our 3D prints first,” said Dr. Decker, associate professor of radiology and director of the USF Health 3D Imaging Lab.

“We are taking multiple data sets to recreate an organ in print so surgeons can use it as a surgical guide. No surgeon is going to operate unless the model is anatomically accurate. I can hand a surgeon their case in advance of surgery and they could tell the patient ‘I’ve used your exact heart to practice’ before going into the actual surgery. This could greatly reduce errors, as well as surgery time.”

Incorporating 3D printing into clinical medicine is fairly new. USF Health’s use of a 3D printer so directly with patient care, especially surgery, and in such close partnership with its primary teaching hospital, is another story altogether, Dr. Decker said.

“There is nothing in our region like this,” she said. “The company that installed our Stratasys printer chose USF Health as a site because of our close partnership with and our proximity to Tampa General Hospital. Having a top-tier hospital and its surgery facilities right next door to our 3D Imaging Lab made all the difference. USF Health has the technology and 3D expertise, and TGH has the surgical cases. We are one in about two dozen in the world, and the first the Tampa Bay area, to do this.”

***

USF Health is this region’s only academic medical center. With three primary missions – research, education, and patient care – Dr. Decker and Dr. Ford could be considered a ‘triple threat’ for incorporating medical 3D printing into all three areas.

In clinical care, their 3D prints are used by physicians at USF Health, and across the globe.

For research, the team has studied and published on this topic for well over a decade and laid the foundational research that confirmed all of the measurement translations taken from scans and incorporated into 3D printed output.

“We had to make the final model anatomically correct or this entire effort would be useless for improving direct patient care,” Dr. Decker said. “It would be just another hobby-level 3D print we’ve all seen.”

Dr. Summer Decker.

And for education, it might not be too far from the truth to say that any clinical institution or hospital building a 3D printing operation today has tapped into the expertise found in the USF Health 3D Imaging Lab.

Dr. Decker teaches resident physicians, and Dr. Ford trains other biomedical engineers. They both present at conferences and host training sessions, graciously and eagerly sharing the details that have made the USF Health 3D Imaging Lab a success.

“Medicine and the field of radiology is changing to include 3D printing, and I want students and residents in many specialties to know about this technology because it will be a part of their careers, I promise them,” Dr. Decker said.

“This is really revolutionary for education,” Dr. Ford said. “You can teach from actual case examples and allow students to interact with a complex pathology in a real tactile sense.”

Dr. Jonathan Ford.

***

Every detail and nuance pertinent to this patient is in that model. Thicker tissue here and thinner there, variations in heart valve size, possible obstructions, etc. – all details that might not show up on the individual scans but, because data is combined, the 3D model now tells the surgeon more exactly what he will face when he is maneuvering around a real heart in his very real patient.

The anatomically correct model is how Dr. Matar knows exactly what he will do during surgery and, perhaps more importantly, what he needs to avoid – all before his patient is in the operating room, before he is under anesthesia.

“The advantages are many,” Dr. Matar said. “Surgeons can see, feel and even ‘practice’ the upcoming procedure before actual surgery. In addition to helping define a stronger surgical plan, it also reduces the time of the surgery, both of which equate to better patient outcomes. Patients can see and better understand their conditions and the treatments and surgeries being recommended, and sometimes why a procedure cannot be done.”

The technology also allows for taking on far more complicated cases, Dr. Matar said.

“We are using three-dimensional printing of cardiac structures for multiple reasons, the most important one is to understand the complex anatomies that present to us how we can tackle more advanced and more complex anatomies.”

***

3D printing is not new – it’s the clinical application of it, building anatomical models, the exact replica of the patient’s organ or skull or spine that is at the forefront of medicine.

3D models of vertebrates after printing for three hours at USF Health’s 3D Imaging Lab.

A 3D print of pancreatic cancer helped a patient have a better understanding why surgery was not a viable option.

Dr. Decker and Dr. Ford have spent the better part of the last two decades learning and refining the printing, then teaching and training others how to incorporate 3D printing into pre-operative planning and patient education.

Dr. Decker and Dr. Ford are clearly making an impact.

This team has won awards, is invited to present nationally, has taught physicians across the world how to effectively implement 3D printing, and has garnered lots of attention from industry media.

“This has gone past ‘wow, this is cool but what can you do with it?’ to actually being clinically applicable and helping save lives,” Dr. Ford said.

Dr. Decker added, “That’s why people are flying to USF Health from all over the world to learn about this.”

Photos and video by Allison Long, story by Sarah Worth, USF Health Office of Communications.

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USF Health isn’t usually called upon to scale the anatomy of a patient from human to animal, but the USF Radiology team has that expertise – and was ready when a Busch Gardens veterinarian reached out to schedule a CT scan for a young sloth with dental issues.

“When it comes to the specialty of radiology, Dr. Summer Decker and her team have been unbelievable,” said Dominique Keller, DVM, senior veterinarian at Busch Gardens Tampa Bay. In the past, USF Health helped the zoological park’s veterinary team with advanced diagnostic scans of penguins and wallabies, but this would be their first sloth.

Kodiak, a 1-year-old, two-toed sloth, was seen by USF’s Radiology team for a CT scan to help determine treatment for an off-set jaw.

USF Health’s Summer Decker, PhD, assistant professor and director of imaging research in the Department of Radiology, holds several patented imaging techniques embracing 3D virtual and 3D printing technologies to visualize anatomy.

“We take pictures in slices and take all of those slices and push them back together to get the exact same patient in 3D,” Decker said. “You can essentially fly through the body.”

Kodiak, a 1-year-old, two-toed sloth, looked as though he was smiling when he arrived at USF in August 2017 for the CT scan. But, in fact, his “smile” was an off-set jaw, contributing to elongated teeth that prevented his mouth from closing properly and made eating difficult. The CT scan would help determine if Kodiak’s issue was a condition caused by his foot-sucking habit or a jaw deformity.

The CT scan and a 3D model of Kodiak’s head helped create  prints that the team used  to develop a dental treatment plan. Periodically filing down some areas of the sloth’s teeth allows his mouth to fully close.

First the radiation dose and scan protocol was modified to meet modified pediatric guidelines by USF CT technologist Joe Henry, and the images were reviewed by neuroradiologist Ryan Murtagh, MD, MBA, associate professor, Department of Radiology.

“Because of Kodiak’s size, he is basically a little kid, like a baby and has to be scanned differently than an adult,” Decker said.

The sloth’s unlikely interprofessional health care team included his veterinarian, a dentist, William Geyer DDS, two imaging research scientists and a radiologist. Before the craniofacial scan, they surrounded Kodiak and worked cautiously, avoiding his “razorblade sharp teeth.” While the images were generated, the team used normal sloth skulls from Busch Gardens’ skeletal reference collection to compare.

3D prints helped the interprofessional  team visualize a treatment plan. From left, Summer Decker, PhD, assistant professor and director of imaging research in the USF Health Department of Radiology; Tampa dentist William Geyer, DDS; and Dominique Keller, DVM, senior veterinarian at Busch Gardens Tampa Bay.

Comparisons from normal sloth skulls shown with a 3D print from Kodiak’s scan.

“None of us had ever scanned a sloth before so we were unfamiliar with the anatomy. Using a reference like the normal skull allows us to determine where Kodiak’s differences are,” Decker said.

The 3D modelling analysis was operated by Jonathan Ford, PhD, biomedical engineer and assistant professor in the Division of Imaging Research at the Department of Radiology. No evidence of a jaw structural deformity was seen. But, Ford was able to virtually open and close Kodiak’s mouth to help identify the areas of jaw and teeth misalignment that led to Kodiak’s bite problem and show the changes that needed to be made to correct the issue.

“That’s why the CT is so nice” Dr. Keller said. “You can take an image, rotate it in three-dimensions and look exactly at what’s happening with him.”

In early October, the Busch Gardens team with Dr. Geyer returned to USF for a follow up. Decker’s team helped provide a treatment plan. A 3D print, made from the scan and 3D model, clearly showed where and how individual teeth would need shaving to correct the sloth’s bite.

Dr. Geyer and USF Health’s Decker review digital models of Kodiak’s craniofacial scans with Joe Henry, USF CT technologist.

A couple weeks later, dental consultant Dr. Geyer shaved down Kodiak’s teeth at the Busch Gardens Animal Care Center with the whole team looking on. The procedure was simple and also a teaching moment for the small group of children who watched behind a glass wall.

“Will he be OK?” they asked.

Kodiak did well. However, his teeth will continue to grow and he’ll need similar dental treatments periodically for the rest of his life.

“This was very different from what we normally do,” said Decker, whose 8-year-old-self was fascinated to learn about sloths and jumped at the opportunity to “draw on all the different fields and combine that knowledge to create a solution.”

USF Health’s radiology team worked with a veterinarian and a dental consultant from Busch Gardens Tampa Bay to form the unlikely team. Members drew upon their different fields to create a solution.

The USF Radiology team thrives in USF Health’s academic clinical environment. Besides being just a call away from Dr. Keller, the clinical researchers have their hands in many other areas such as gynecology, neurosurgery, cardiothoracic surgery, plastic surgery, pathology and forensics, to name a few. Their expertise is routinely tapped by physicians and surgeons to help create “roadmaps” for treating patients, and they teach medical students and residents innovative, advanced imaging techniques.

“We need that collaboration. To me that’s the beauty of working near an academic medical institution, and USF is perfect for us,” Dr. Keller said.

A story about how the USF Health radiology doctors worked with the Busch Gardens Tampa Bay veterinary group to find a solution to Kodiak’s dental problem aired April 21 on the show Wildlife Docs.

-Video by Ryan Noone and Torie Doll, and photos by Ryan Noone, University Communications and Marketing
-Anne DeLotto Baier contributed to this story

Tampa, Fla. (Aug. 27, 2014) — The Florida Aquarium’s rescued sea turtle Freud took another trip to USF Health for a second round of high-tech diagnostic help — this time using USF Health Radiology’s state-of-the-art advanced imaging systems.

Freud, an endangered green sea turtle was found lethargic, bloated and covered in algae on Navarre Beach in November 2012. He was then transferred to The Florida Aquarium in January.  Suffering from a suspected a tear in his lung, Freud was taken to the USF Health’s Center for Advanced Medical Learning and Simulation (CAMLS) facility in December 2013. The Aquarium vet staff, along with faculty members from USF Health Radiology, and Dr. Luis Llerena, medical director of CAMLS Surgical and Interventional Training Center, performed a CT scan and bronchoscopy on Freud to see if there were any injuries potentially causing air to fill his body and impeding the sea turtle’s ability to swim.

Freud, the rescued green sea turtle, arrives at the USF Health South Tampa Center for Advanced Healthcare for CT imaging to verify whether his injury had healed.

When no obvious signs of damage appeared on the bronchoscopy, the CT scans were taken back to USF Health Radiology for further analysis. A team from the USF Health Morsani College of Medicine’s Department of Radiology including Dr. Summer Decker, director of imaging research and assistant professor;  Dr. Todd Hazelton, professor and chairman; and Dr. Jonathan Ford, biomedical engineer, analyzed the scans and created three-dimensional models of Freud’s lungs to visualize the extent of the damage. Working with sea turtle expert Dr. Doug Mader of the Marathon Sea Turtle Hospital, it was determined that Freud had a bronchopleural fistula, an abnormal connection between the small air tubes of lung and the space around the lung. The Florida Aquarium and USF Health Radiology collaborated to create a treatment plan for Freud’s recovery.

Since the diagnosis was confirmed in January, The Florida Aquarium team has been working with Freud on his recovery and in the recent months saw huge improvements in his swimming abilities. Whereas he was previously seen floating on the surface, Freud was now able to swim to the bottom of the tank and glide across the water effortlessly.

Susan Coy, a veterinary technician with The Florida Aquarium, positions Freud as Dr. Summer Decker of USF Health Radiology looks on.

The Florida Aquarium veterinarian, Kathy Heym explains: “We had been monitoring some slight progress in Freud’s rehabilitation and felt confident that he was slowly getting better.  It wasn’t until a couple months ago when we first noticed that he was able to rest comfortably at the bottom of the tank that I knew we needed to get him back to USF Health for a follow-up CT scan.”

Up until this point Freud was barely able to dive underwater so seeing him resting at the bottom was a huge accomplishment in itself, but because the tear in his lung was so small, the staff at The Florida Aquarium was unable to make a definite diagnosis stating he was completely healed. The Aquarium once again reached out to their partners at USF Health Radiology for help.

Setting the target for the CT scan.

The team set up another CT scan but this time at the USF Health South Tampa Center for Advanced Healthcare  imaging facility on the Tampa General Hospital campus. They wanted to determine if Freud’s fistula had completely healed, making it possible to release him back into the wild.

“The advanced imaging technology here at USF Health combined with the amazing teamwork between USF Health and The Florida Aquarium played a vital role in making sure Freud would have the best possible chance to recover. We couldn’t be more pleased with the outcome and opportunity to work alongside our friends and collaborators at the Aquarium. This has truly been a team effort,” said Dr. Decker, the USF Health Radiology team leader on the project.

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The CT scans confirmed that Freud’s injury has completely healed with minor residual scarring, so he can now safely be released back into the wild.  The Florida Aquarium team is working with Florida Fish and Wildlife on determining when and where Freud’s release will take place, but this is a huge accomplishment for The Florida Aquarium and USF Health partnership.

“We simply couldn’t have done it without the help of our friends at USF Health” said Heym. “Freud’s success is due in a large part to their willingness to utilize their equipment and expertise to help us make a proper diagnosis and develop a plan of action to successfully treat this turtle. We are extremely thankful for their support.”

Dr. Jonathan Ford, biomedical engineer, and Dr. Decker examine a 3D model of Freud’s lungs.

L to R: Dr. Todd Hazelton, professor and chairman of the USF Health Department of Radiology; Dr. Summer Decker, director of imaging research and assistant professor of radiology; Kathy Heym, The Florida Aquarium veterinarian; and Susan Coy, veterinary technician.

Now that Freud’s injury has completely healed with minor residual scarring, The Florida Aquarium is working with Florida Fish and Wildlife to determine when and where the endangered sea turtle’s release will take place.

Photos by Eric Younghans, USF Health Communications

About The Florida Aquarium:
The Florida Aquarium is a 501(c)(3) nonprofit institution whose mission is to entertain, educate and inspire stewardship about our natural environment. The Florida Aquarium is home to more than 20,000 aquatic plants and animals representing species from Florida and around the world.

About USF Health:
USF Health’s mission is to envision and implement the future of health. It is the partnership of the USF Health Morsani College of Medicine, the College of Nursing, the College of Public Health, the College of Pharmacy, the School of Biomedical Sciences and the School of Physical Therapy and Rehabilitation Sciences; and the USF Physician’s Group. The University of South Florida is a Top 50 research university in total research expenditures among both public and private institutions nationwide, according to the National Science Foundation. For more information, visit www.health.usf.edu

Media contacts:
Katherine Claytor, The Florida Aquarium: 813-486-1645, kclaytor@flaquarium.org
Anne DeLotto Baier, USF Health Communications: 813- 974-3303, abaier@health.usf.edu

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As the anesthesia took full effect, Freud dozed on the surgical table at the USF Health Center for Advanced Medical Learning and Simulation.

The juvenile green sea turtle was oblivious to the crowd of reporters and photographers recording every move of The Florida Aquarium and CAMLS team preparing the docile creature for a series of advanced imaging tests to help diagnose a suspected tear in the lung.

Veterinarian Kathy Heym, DVM, had reached out last month to CAMLS, The Florida Aquarium’s downtown neighbor, for assistance in finding the source of injury, or leak, causing the body cavity outside the turtle’s lungs to abnormally fill with air.  All that trapped air creates undue pressure on the turtle’s shell and organs, creating a potentially life-threatening condition as he matures.  It also means Freud floats a lot, so  he cannot swim long enough at depths or dive down  for meals of sea grasses; the aquarium staff serves him food on a pole.  In the wild, a super-buoyant turtle would likely soon be an easy target for predators.

“Working with the CAMLS team to go the extra mile for this animal has been phenomenal,” Dr. Heym said.  “They’ve provided us access to imaging technology and special instruments that we would not usually have access to.  It’s great to have this type of support in our own backyard.”

“CAMLS is the world’s largest simulation and training center with cutting-edge technology. We’re also a good neighbor,” said USF Health trauma surgeon Luis Llerena, MD, medical director of CAMLS Surgical Intervention and Training Center. “So, when The Florida Aquarium came to us, we said we’d love to help.”

Getting their first look at the sea turtle, Tampa Bay area media surround Freud, who was brought into the CAMLS Surgical and Interventional Training Center in a small crate.

At 22 pounds, Freud is estimated to be age 10 to 15; sea turtles can grow to over 300 pounds and live 80 to 100 years.  Though referred to as “he,” the young sea turtle’s sex is undetermined because he hasn’t reached the age of sexual maturity.

Freud was stranded on a beach in the Florida Panhandle in November 2012. The listless sea turtle was covered with algae and bloated when rescued and brought to Gulf World Marine Park in Panama City Beach for rehabilitation.  He was transferred to The Florida Aquarium, the Tampa Bay area’s largest aquarium, in January 2013.

Before arriving at CAMLS for advanced diagnostic testing, Freud underwent a couple of inconclusive computed tomography (CT) scans and a laparoscopic procedure, without success in pinpointing the potential hole or holes  leaking air from his lungs.

Susan Coy (left), veterinary technician for The Florida Aquarium, preps sea turtle Freud for the series of CT-scans, which were performed by Summer Decker, PhD, director of research imaging at USF Health Radiology.

Kathy Heym, DVM, veterinarian at The Florida Aquarium, speaks with USF Health trauma surgeon Luis Llerena, MD, medical director of the CAMLS Surgical and Interventional Training Center.

The Dec. 10 visit to the university’s simulation center involved two procedures.

First, Freud underwent a series of CT-scans enhanced for clarity and maximum detail by USF Health researchers with expertise in three-dimensional imaging and pre-operative planning.  Summer Decker, PhD, director of imaging research at the Morsani College of Medicine’s Department of Radiology, said the scans she captured would be shared electronically with Todd Hazelton, MD, USF Health chair of radiology, and colleagues at  the Georgia Sea Turtle Center and Marathon Veterinary Hospital in the Florida Keys so they could offer additional insight.

Secondly, while in sum the three CT-scans indicated that Freud’s lungs appeared healthy, the team decided to perform a bronchoscopy to try to localize the site of the leaking air.  Dr. Llerena  inserted the thin fiberoptic scope with miniature camera attached down the sedated turtle’s windpipe to view inside the airways.

“On a turtle what’s a normal CO-2 (carbon dioxide) reading?” Dr. Llerena turned to ask Dr. Heym, who helped guide him through the process carefully monitored by the The Florida Aquarium’s veterinary team.  “This is really different than a human.”

Assisted by the veterinary team, Dr. Llerena prepares to insert the specialized bronchoscope into the sedated turtle’s windpipe to get a view inside the animal’s airways.

As Dr. Llerena carefully manipulates the high-tech scope through Freud’s airway, a real-time view appears on the monitor above.

The bronchoscopy showed air bubbles where smooth tissue should be at the left-side base of Freud’s lung.  Dr. Llerena was able to pinpoint and record on videotape for further review the location of the bubbles (lesions). The next step, Dr. Heym said, will be to correlate the CAMLS CT-scan findings with the bronchoscopy results. Taking that information,  sea turtle veterinary experts could brainstorm with human pulmonologists and surgeons, to figure out if there is a least invasive approach for repairing the potentially life-threatening condition given the anatomical limitations of surgery on a turtle.

CAMLS worked with partners — including STORZ, the medical device company that supplied the specially-sized bronchoscope, and Stryker – to make sure that the high-tech diagnostic evaluation was adapted to meet the needs of the aquarium’s patient.  Even the CT-scan radiation dosage protocol was modified to account for the sea turtle’s pediatric size.

“This turtle would have a really difficult time with us finding a solution, if we didn’t have the opportunity here today.”  Dr. Heym said, referring to CAMLS donation of staff time, equipment and facility.

Sea turtles play a critical role in the ecological system and health of the earth’s oceans, so teaming up within the community to help save the animals benefits everyone, she added. That’s also why the best-case scenario would be to find a fix for what ails Freud and release him back into Florida waters, close to where he was rescued.

Florida is home to five species of sea turtle and most, including Freud’s green turtle species, are endangered.

“So every turtle counts,” Dr. Heym said. “That’s the ultimate goal with all these guys – to get them into rehab and get them back out there, so they can contribute to (increasing) the population moving forward.”

L to R: The USF Health team — Jonathan Ford, biomedical engineer for the Department of Radiology, Summer Decker, director of research imaging for Radiology; and Dr. Luis Llerena, medical director of CAMLS Surgical and Interventional Training Center; with The Florida Aquarium team — Susan Coy, veterinary tech; John Than, associate curator; and veterinarian Kathy Heym, DVM.

Photos by Eric Younghans, USF Health Communications, and video by Allyn DiVito, USF Health Information Systems

Summer Decker, PhD, of the USF Health Department of Radiology, recently led a team project in USF’s Master’s of Science in Entrepreneurship in Applied Technologies program, which used social media to  raise more than $2,000 in four days for a hunger-relief charity.

Summer Decker, PhD

Decker, assistant professor and director of imaging research in the radiology department, worked with a team of fellow students in the College of Business New Venture Strategy course led by professor Sean Lux, PhD.    Lux issued all the  student teams  in his class a challenge.

“We  had one paper clip to start a business and raise as much money as we could within a week,” Decker said. “The previous record (for a team) was $600.”

To read more about Decker’s entrepreneurship project to benefit a charity, click here.

Check out the project web page Decker designed at  http://www.gofundme.com/4nll88