Biden-Harris Administration announces ARPA-H awards to develop novel technologies for precise tumor removal  

PSI performer teams aim to deliver groundbreaking tools enabling surgeons to successfully remove tumors through a single operation

The Advanced Research Projects Agency for Health (ARPA-H), an agency within the U.S. Department of Health and Human Services (HHS), announced the first eight teams selected by its Precision Surgical Interventions (PSI) program to receive awards. The agency’s commitment is not expected to exceed $150 million to develop novel technologies that will allow surgeons to remove cancerous tumors with higher accuracy. If successful, these technologies will revolutionize surgeries, dramatically reducing rates of repeat procedures. They can also reduce instances of unintentional injury to critical structures such as nerves, blood vessels or lymph ducts. These imaging tools may also be used to improve other types of surgeries.   

“From the start, ARPA-H has had a singular purpose: to drive breakthroughs in health, including cancer. Revolutionizing surgical techniques is a critical step forward towards improving detection and treatment of cancer, and improving the overall patient experience in the process,” said HHS Secretary Xavier Becerra. "The Biden-Harris Administration is committed to reducing the cancer death rate by at least 50 percent over the next 25 years. This goal is becoming more and more achievable thanks to breakthrough treatments and innovative technologies like these.”  

“With the Precision Surgical Interventions program, we're seeking to fundamentally change how surgery is done. PSI and its technical performer teams are committed to developing tools that reduce the rate of reoperations or accidental damage to critical structures,” said Ileana Hancu, Ph.D., ARPA-H PSI Program Manager.   

ARPA-H selected these awardees to develop methods and techniques to improve cancer detection and increase the visibility of critical anatomical structures during surgery. PSI will pursue two technical areas: cancer localization (technical areas 1-A and 1-B) and healthy structure localization (technical area 2).   

Technical area 1-A performers will focus on visualizing the surface of excised tumors and identifying if there are any cancer cells left. If so, the surgeon will be able to remove more  tissue prior to completing the surgery. The performers will use different microscopy techniques to visualize the surface of the removed tissue with sub-cellular resolution. All images will be read and classified automatically, without the need to have pathologists in the operating room:  

• Tulane University will build an imaging system that uses a large aperture camera and structured illumination microscopy, an imaging technique that uses patterned light to achieve high resolution in three dimensions. It takes advantage of light wave interference patterns to image entire excised tumors. The team will also develop an AI algorithm to automatically identify cancerous cells for fast data classification. Total award up to $22.9M. 
• Rice University will build a novel microscope that images tumor slices with ultraviolet epifluorescence. They will use advanced methods to create fluorescent stains that label cells and cellular components and will develop automated AI algorithms to transform their images into ones that look similar to conventional pathology. They will also develop an automated pathology algorithm to classify the imaged cells. Total award up to $18.0M. 
• University of Washington will develop a microscopy system to allow surgeons to image the entire surface of the tumor by placing it on a lightsheet scanner. The team is also developing algorithms to pseudo-stain the resulting images, so that the sample doesn’t need to be dyed in the operating room; instead, AI methods will take a greyscale image and render it similar to conventional pathology images in order to better classify it.  Total award up to $21.1M. 

Technical area 1-B performers will focus on identifying microscopic cancer remnants inside the patient to help the surgeon remove all remaining cancer cells before the end of the procedure:  

• University of California, San Francisco is inventing a microscope that uses an optical array that is pressed into the cavity’s surface. Each pixel is its own multicolor microscope. The investigators are also developing a multi-cancer dyeing agent that activates based on enzyme activity in tumors. Total award up to $15.1M. 
• University of Illinois Urbana-Champaign will develop optical coherence tomography techniques to find suspicious tissue structures in the surgical cavity, then image those regions with nonlinear optics, which will give a multilayered view of the cells’ metabolism and structural properties. Total award up to $32.6M. 
• Johns Hopkins University, which is performing on both technical area 1-B and technical area two, will develop a novel non-contact, photoacoustic endoscope to provide a more colorful view of the surgical field without altering the surgeons’ workflow. They will also develop a multi-cancer fluorescent contrast agent.  Total award up to $20.9M. 

Technical area 2 performers will focus on making critical anatomy more visible to surgeons:  

• Dartmouth College is creating a laparoscope-integrating imaging solution that will be especially helpful in prostate cancer surgeries. They will use nerve-dyeing and ureter-dyeing contrast agents, in addition to vascular dyes, to cause these critical anatomical structures to fluoresce. They will then map and visualize the 3D shape and depth of the structures.  Total award up to $31.3M. 
• Johns Hopkins University will use existing fluorescent dyes in combination with their novel photoacoustic endoscope to visualize anatomical structures for surgeons. The endoscope will ‘see’ deep into human tissue to reveal hidden blood vessels and nerves, such as they are not accidentally cut. (See above) 
• Cision Vision will use shortwave infrared and hyperspectral images to help surgeons visualize blood vessels, nerves, and especially lymphatic structures. Going well beyond red, green, and blue, hyperspectral imaging is enhanced by AI algorithms. This would allow the team to distinguish between tissue types without administering dyes.  Total award up to $22.3M. 

“With PSI, we aim to reduce surgical errors significantly and achieve better health outcomes across cancer and other diseases,” said ARPA-H Director Renee Wegrzyn, Ph.D. “Surgical procedures are often the first treatment option for some two million Americans diagnosed with cancer each year. This lack of precision can lead to repeat surgeries, harder recoveries, cancer recurrence, and higher health care costs. Our hope is to advance cancer surgery so that we remove cancer the first time and every time.”  

The PSI program mandates that all performers design solutions that are compatible with all users. For example, if designing a tool for surgeons, the tool must fit different hand sizes. PSI mandates that all performers also be committed to equitable access and the development of medical devices that will be useable in virtually any hospital. As such, PSI performers must prioritize lower-cost solutions in their designs and test their devices in a rural hospital during the program. Furthermore, the devices must be validated in patient populations that reflect the demographics of the disease studied.  

The performers’ awards are ceilings, based on each performer meeting its contractual milestones. ARPA-H’s total investment is not expected to exceed $150M. 

For more on PSI, visit the PSI program page.