Two Mass General Research Groups Share Resources, Lab Space and a Vision for the Future

Two successful, well-established orthopedic research laboratories at Massachusetts General Hospital and Harvard Medical School have combined their resources to double their research capacity, innovative power and creative output. The Foot and Ankle Research and Innovation Lab (FARIL) and SORG Research Group (formerly the Skeletal Oncology Research Group) now share laboratory facilities and have combined their workforces to operate as one group. The collaboration has increased their ability to develop new solutions for musculoskeletal patient care quickly.

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"Before, our labs were working in silos; while most of our projects were overlapping, we were working in parallel and unaware of each other's work. Our resources were divided and there were redundancies," says Soheil Ashkani-Esfahani, MD, director of FARIL. "Last year, lab leaders Christopher W. DiGiovanni, MD, Joseph H. Schwab, MD, MS, and Hamid Ghaednia, PhD, and I met to discuss how we could combine our workforces to better allocate resources and empower the researchers in our department to collaborate and think outside the box. As a department, we want to encourage collaboration and eliminate silos. It makes sense from both an economic and an academic standpoint."

Together, the two research teams are applying their medical expertise, research experience and engineering ingenuity to solve some of orthopedics' biggest challenges. They aim to improve and accelerate diagnostic methods, develop new medical devices like wearable monitors, and inform treatment decisions by developing algorithms that predict patient outcomes using artificial intelligence (AI) and machine learning.

Two Research Labs Become One

Each individual lab is already world-renowned for research and innovation in its respective field.

FARIL focuses on creating new approaches to diagnosing and treating common and complex foot and ankle problems. The lab's staff specializes in developing and testing new diagnostic and surgical methods and technologies like three-dimensional imaging, handheld ultrasound devices, and AI prediction models.

SORG has developed some of the world's leading predictive algorithms for outcomes in spine disorders and musculoskeletal oncology, and its researchers have invented wearable medical devices for monitoring and assessing patients with musculoskeletal disorders, spine pathologies and tumors. SORG regularly publishes research on spine injuries and tumors and has been overseeing the Mass General Orthopaedic Registries.

Now, the two labs are working together on projects that started when they were separate entities, along with some new broader initiatives. All collaborations benefit from a larger team, more equipment, and increased productivity from the new combined method. "It's led to an explosion of research," says SORG Co-Director Hamid Ghaednia, PhD. "It really shows the power of teamwork. People with different backgrounds, from different areas and institutions, working together on exciting projects—this is what emboldens us and leads to innovation and success." Drs. Ghaednia and Ashkani stress that the collaboration could not have happened without the support of the orthopaedic surgery department's leadership, specifically Chief Mitchel B. Harris, MD, and department Executive Vice Chair Christopher M. Bono, MD.

Clinical Decision Support Innovation

One of the major themes of these labs is clinical decision support. "We are developing AI that can replicate or try to replicate the quality of care at Mass General," Dr. Ghaednia says. "We want patients and clinicians in hospitals worldwide to have access to algorithms based on patient data that can give them the same quality of care and informed decision-making that you'd get from a highly skilled surgeon."

The labs are using AI to aid clinicians in:

• Diagnosis: The labs use machine learning and AI to develop tools to assist clinicians worldwide with diagnosis. For example, they have developed a way to diagnose ankle deformities using a cell phone camera. They have also established new methods to assess femur fractures and bone tumors. Many of these projects are built on image data housed in a Mass General registry system maintained by FARIL and SORG
• Treatment decisions: Support tools help clinicians make treatment decisions based on predictive algorithms. The groups have developed algorithms that predict outcomes of individual treatment options, including risks, costs, and benefits. For example, one algorithm can predict the likelihood of venous thromboembolism (VTE) after surgery to inform prophylaxis administration
• Prognosis: The labs' predictive algorithms are also helping to determine prognosis in many different patient populations. One approach involves using patient-reported outcome measures (PROMs) to assess the likely course of a disease or injury and reduce complication risk. Another example is using an algorithm to predict the mortality of bone cancers in both surgical and non-surgical patients
• Rehabilitation: Gaming technology is a part of many of the collaborative's innovations because of its popularity with both researchers and patients. For example, a patient might ride a stationary bike through a virtual "jungle" while equipment monitors their biomechanical performance. Another gamified project involves an avatar instructing patients to perform physical therapy exercises while the software evaluates range of motion and adjusts the therapeutic regimen
• Follow-up: Some of the labs' devices and algorithms can help monitor the effectiveness of post-surgical rehabilitation and use PROMs and examination notes to help determine the optimal time for patients to return to sports or work
• Education: Educational platforms, games and quizzes teach medical students and orthopedic residents important information while assessing them for knowledge and burnout (burnout is a major concern in orthopaedics). FARIL-SORG has also launched an educational podcast on YouTube to share their findings globally

"The ultimate goal is to bring all of these projects together to maximize clinical efficiency and improve patient outcomes," Dr. Ghaednia says. "We're also finding ways to maximize access of our tools and findings for a global community of clinicians and laypeople."

The labs' work is supported by major grants and industry funding, and the research teams always welcome new multidisciplinary partners seeking to pioneer new approaches to musculoskeletal care.

Rare Example of Diversity in Orthopedics

The collaborative has 58 researchers, including undergraduate students, graduate students, PhD candidates, postdoctoral researchers, physicians and surgeons. They represent multiple specialties, 37 with medical backgrounds and 21 engineers. The staff includes clinicians, surgeons, electrical engineers, biomechanics experts, data scientists, bioengineers, and game developers.

And in a field known for being one of the least diverse in medicine, FARIL and SORG have a wide variety of contributors. The researchers, more than 50% female, represent many racial groups and hail from 19 countries and 10 different states.

The facility is also quite diverse at the James C. Alex, MD, Research and Innovation Center. Inside the homey building covered with shaker siding and lush, mature greenery are a collection of high-tech spaces. One space is set up for AI engineering, one is home to clinical research and biomechanics, and another space is dedicated to cellular and molecular research. The center has a prototyping room with two 3D printers that researchers have been using to print medical devices they develop. Benefiting from a huge virtual reality and game engineering space, the collaborative has invested in developing entertaining educational platforms for both providers and patients. The center has a machine shop, two conference rooms and even a podcast and digital media room being used to discuss and share its research.

Creating a Fun Collaborative Environment

Despite the serious nature of the work and the intense productivity, the lab takes time for team building and fun. They host weekly events, such as volleyball, basketball, and soccer competitions; barbecues; birthday parties; and journal clubs. And even though the two labs have merged, the researchers aren't territorial, instead embracing a collaborative culture built on collegial friendship.

"There is a true sense of teamwork and trust here. Everyone brings everything they have. They don't care if they are an author on this paper or that paper, or if they are receiving credit for the help they offer each other. It's our job to make sure they receive the proper credit and are supported—they trust us, and we trust them," Dr. Ashkani-Esfahani says. "They all say, 'It's my lab.' We're like a big family. That's the culture."

Learn more about the Foot and Ankle Research and Innovation Lab

Learn more about the SORG Research Group