It’s All about Synergy: In Conversation with Dr. Jonathan Irish

It’s All about Synergy: In Conversation with Dr. Jonathan Irish

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By: Adam Betel

Faculty Affiliations: Dr. Jonathan Irish, MD, FRCSC, MSc
Core Lead, Institute for the Advancement of Technology for Health
Chief, Department of Surgical Oncology, Princess Margaret Hospital
Associate Member and Alumnus, Institute of Medical Science

Why is it that after the Beatles broke up, no individual member was able to rival the success achieved together as a group? Individually there’s no question that Paul McCartney, John Lennon, and George Harrison had incredible talent (and Ringo too, for all you Yellow Submarine fans out there). But what was it about being together that made them one of the most recognizable, successful, and influential music groups of the 20th century? It’s synergy and that’s what has been carrying Dr. Jonathan Irish and his GTx team at the Princess Margaret Hospital and the TECHNA Institute to make great strides in high-tech surgery.

Dr. Jonathan Irish graduated from the Faculty of Medicine at University of Toronto (U of T) in 1984, before returning to U of T in the Institute of Medical Science (IMS) in 1991. Dr. Irish works concurrently as the Chief of Surgical Oncology at Princess Margaret Hospital and the Core Lead for the Guided Therapeutics core (GTx) at the TECHNA Institute, a division of the University Health Network.

GTx refers to the combined use of robotic imaging, real time MRI tracking, and surgical navigation technology to guide and assist physicians during surgery. However, the success of GTx in treating patients extends beyond the surgeons and the operating room. Before application in the clinic, GTx technology is tested and refined in the GTX lab. Just like the Beatles had a studio to rehearse in, so does Dr. Irish and his team. Inside the MARS building on the 7th floor is the GTx lab, a space equipped with a pre-clinical model operating room, two 3D printers, as well as dedicated space for testing new technologies. Just as the Beatles spent hours rehearsing in the studio and performing at Berlin nightclubs, the GTx team goes through rehearsal in the lab. The actual GTx Operating Room is located inside Toronto General Hospital in a large room fit with a cutting edge robotic CT scanner, in addition to large monitors and usual surgical equipment.

The team’s efficiency in clinic is the result of the time and effort spent in the GTx lab. There they use the 3D printers to recreate and simulate patient anatomy for surgeons to practice on and for the whole team to reproduce studies. Reproducibility is key to innovation and making advances in medical research. The GTx team’s ability to innovate is matched by their mandate to translate and educate as well. This extends not only to engineers, surgeons, scientists, but to the public as well.

“The GTx program is one of the pillars of the TECHNA Institute, which is a research institute dedicated to the development of new technologies and implementation,” explains Dr. Irish. “I like to view the GTx program as a U of T resource, not just a UHN resource […] we’re only as good as our human resource and our human resource includes our students.”

Dr. Irish’s research team is unique as it brings scientists from different disciplines together. Just like John and Paul would often explore with other instruments, in the GTx lab and OR, clinicians, scientists, and engineers explore different roles within the team. For example, it’s not uncommon to see a doctor at work in the lab behind a computer, or an engineer in scrubs in the OR. This is the synergy.

In addition to being a means of team collaboration, GTx has also become a means of institutional and departmental collaboration. For example, the GTx OR is shared quite frequently with the Peter Monk Cardiac Centre, part of the Toronto General Hospital. “The greatest possible compliment that you could get [is] when a world class […] program wants to use your resource,” says Dr. Irish.

Dr. Irish credits much of his success to synergy. “This day and age there is no question that synergy and partnerships and collaborations are absolutely required to success,” he explains. “And I think that’s what has been the foundation of how I have been able to be reasonably successful in almost all of the fields that I’ve undertaken is the fact that I collaborate.”

It’s easy for regular people to see how the technology will be helpful. “When people walk into our GTx lab or our GTx-OR, it has some immediate attractiveness because they can actually appreciate the tangibility of some of the things that were doing,” he says. “You can see real impact, in a relatively short period of time and you can understand ‘ya, I get that’, there’s a coolness factor.”

Some of the tangible research and innovation that Dr. Irish has been working on includes using contrast agents to mark cancer cells and live feedback dashboards to map and track surgery in real time. In addition, he’s utilized 3D modeling to predict and accentuate reconstruction after head and neck cancer surgery and hand-held spectroscope devices that allows for imaging over 3D volume. He also discussed using novel agents to replace traditional agents in areas like sentinel lymph node biopsies. The innovation coming from the GTx lab also goes through development quite rapidly, for medical research. “We’ve taken some of the technologies that we’ve developed in our GTx lab from proof of principle or a thought, to in-patient within two years. That’s kind of cool. There’s no drug that’s ever done that.”

A pride Dr. Irish takes from his research is that it is disease agnostic. In other words, it can be translatable across all disciplines. Dr. Irish primarily uses GTx for head and neck cancers–his specialty–but the same technology and guiding principles can be used to treat entirely different diseases.

Dr. Irish’s advice to current IMS students is to stay broad, and not to specialize too early. Be multi-disciplinary and then focus your work. “Over time you will find your passion and you will explore and develop that foundation into areas of expertise that will take you forward,” he says.

“But, it’s pretty clear that, at least in science and medicine, that engineering and technology and nanomedicines and nanotechnologies are going to play an increasingly stronger role in medical research.”

The innovation and medical progress coming from Dr. Irish’s work comes from people working together, across faculties, institutions and disciplines. This is a powerful message and an example of the incredible opportunity brought about through the IMS at U of T. Your journey has begun, and now, like Dr. Irish, you need to build up the right team to create your synergy and change the world. The Beatles may have sung it, but the GTx team definitely listened, “I get by with a little help from my friends.”