Dr. Brandon P. Brown, Assistant Professor in the Department of Radiology and Imaging Sciences, is the director of the department’s Fetal and Perinatal Imaging Program and a founding member of the new Fetal Center at Riley Children’s Health here on campus. He also has appointments in Pediatrics, and Obstetrics and Gynecology.
Brown enjoys the interdisciplinary nature of the clinical and research teams in perinatal medicine, with cooperation of physicians from multiple departments and disciplines from the School of Medicine, including neonatologists, pediatric cardiologists, pediatric surgeons, maternal/fetal medicine physicians, geneticists and genetic counselors, palliative care, neurosurgery and neurology, among others. Brown believes strongly in a highly integrated role for radiologists, working side by side with other disciplines to maximize patient care and improve outcomes, in stark contrast to the stereotype of an isolated radiologist, cut off from clinical care.
“[The fetal center] is not simply a building or structure; it is a close-knit network of relationships and collaborations. The meetings in which many caregivers come together to consult on prognosis and treatment planning are where irreplaceable work is accomplished, and our multidisciplinary family counseling sessions add real value for these patients,” states Brown.
At the beginning of last year, the establishment of the new Fetal Center at Riley Children’s Health was announced. The teams working within the Center are particularly focused on the most medically complex and high risk pregnancies. A diverse group of physicians and other caregivers review each individual patient, meet to discuss and analyze how best to treat the patients, and then host a counseling session to discuss with the family.
“Medical imaging plays a particularly important role for these cases, in which we cannot see or directly examine the fetal patient. Nearly everything we know about them is through imaging. In the Fetal Center, there are an infinite number of potential problems. Every case is different.”
It is this individual approach to patient care that aligns with IU School of Medicine and IU Health’s recently announced Precision Medicine initiative, emphasizing customized care for each patient.
Alongside these clinical initiatives, there are multiple parallel research investigations, which are the result of the aligned efforts of obstetrical, pediatric, and surgical specialists. These research efforts have three main goals. First, the aim is to better understand how to best utilize prenatal imaging to diagnose and treat complex congenital anomalies. A second goal is to enable care for families through proper prenatal counseling. A third goal is to develop a registry of complex fetal cases that are referred here, including records of therapies, outcomes, and mortality.
“While we have much to offer these families in the way of disease therapy and perinatal critical care, we also must recognize our own limitations in order to be responsible caregivers. That includes being clear about what is and what is not possible. Our task is larger than simply diagnosis and treatment. Comprehensive care for complex congenital anomalies is much broader than any one procedure. To provide excellent care, we must shepherd the family through the sometimes long and challenging journey that they face. We have to do our utmost to prepare them for what’s coming.”
“We are thinking outside the box as to how radiologists can be helpful. It’s central to collaborative patient care to bring diverse thinking into one conversation. Radiology has an opportunity to be a leader in bringing specialties together,” states Brown. “We are all recognizing that we need to work in concert.”
In the future, Brown wants to share his experiences here with the broader fetal medicine community. Outside pediatric medical centers, including some in Texas and Minnesota, have consulted IU Radiology about starting or improving their own fetal imaging. In addition, through efforts by Riley Children’s and Texas Children’s hospitals, fetal imaging programs across the country are beginning to compare challenging cases and best practices with each other through a new online colloquium that has begun.
This increased emphasis on improved communication between medical disciplines may be a model for more than just fetal care. “Each of us knows something different about the patient, and it can be remarkable when we take the time to learn from one another. The Fetal Center is taking multidisciplinary healthcare to a much more integrated level, and I believe that moving in this direction could benefit many other parts of the medical community.”