Miller School of Medicine Orthopaedic Oncology Chief Dr. Brooke Crawford on AI, Fracture Prediction and Mentoring Future Surgeons
Dr. Crawford discusses her leadership at Sylvester Comprehensive Cancer Center, research using AI to predict bone fractures in cancer patients and her approach to training the next generation of orthopaedic surgeons.
As chief of orthopaedic oncology at Sylvester Comprehensive Cancer Center, part of the University of Miami Miller School of Medicine, Brooke Crawford, M.D., MBA, sees cancer care as a leader, a surgeon, a researcher, a collaborator and a mentor.
Dr. Crawford, a professor of orthopaedics at the Miller School, shares about her work in the following interview, which has been edited for length and clarity.
What is your role as chief of orthopaedic oncology at Sylvester?
It’s a dynamic job. The orthopaedic aspect involves operations of the orthopaedic oncology service: how our clinics and operating rooms are run and post-op care. It’s also developing, with my partners, the division’s research infrastructure.
My role also has multidisciplinary aspects to it. For example, one of our initiatives as a sarcoma group with the medical oncologists and the radiation oncologists was to get nurse navigation going for patients. We just ran a trial with a nurse navigator, who started May 15.
You grew up in rural Oregon. What was your path to Miami?
I did a few extra years of training to get into orthopaedics, because it’s a highly competitive field. I did my residency at St. Louis University and my fellowship in Boston with Dr. Fran Hornicek, who’s now chair of the Department of Orthopaedics at the Miller School.
When Dr. Hornicek became chair at UCLA, he recruited me. When he came back to Miami, I was drawn by the opportunity to work with him and Dr. Temple. It was clear that Sylvester and the department were going to work together to build the orthopaedic oncology program, so that was exciting.
July is Sarcoma and Bone Cancer Awareness Month. What research are you doing to help patients with bone tumors?
The most common problem we see as orthopaedic oncologists is metastatic disease to the bone. This is stage 4 cancer, so most patients are on chemo or targeted therapy and they may not be able to continue, if they need surgery. On the other hand, if their bone is about to break and we can prevent it, their outcomes are much better. But it’s hard to take people off their medications for surgery if you don’t know for sure their bone is going to break, and existing models are bad at predicting it.
One arm of our project is to take AI and put in scans of normal bones, then compare those to metastatic images and start to teach the AI to help us predict, based on imaging alone, how likely a person is to fracture their bone.
But the tumors matter, too. The other arm of our project is to look at whether or not patients are breaking bones or having functional pain, and trying to find biomarkers in the tumor’s genetics that correlate with the patient’s clinical skeletal outcomes.
We’re hoping to merge the two things and come up with a predictive model.
As associate program director of the Miller School’s orthopaedic surgery residency, how do you mentor residents?
What I want residents to think is, every time you’re introduced to a patient, you should take responsibility, as if you’re the only orthopaedic surgeon that patient’s ever going to see, even though in our academic environment, this isn’t true. I tell them to put in place a plan that’s going to get you from point A, where you are right now, to point Z, where you need to be.
This approach encourages residents to hold themselves accountable to their patients, and it works. Patient satisfaction gets really high and residents engage with patients in a way that makes them want to learn more about a patient’s case and what they would do with the situation.
What do you enjoy outside of work?
I’m a farm girl at heart. I grew up on a 60-acre property, but my profession requires me to live in big cities. I live on a one-acre lot, and I have a couple cattle dogs and a cat, all rescues. I have fallen in love with paddleboarding in South Florida. I don’t have my mountains to hike with my dogs anymore, so I go out on the water.
My new favorite animal is a manatee. The other big thing for me is my family. My nieces and nephews are getting older, so it’s been fun helping them figure out what they want to do as they grow up.
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Dr. Brooke Crawford worked with orthopaedics chair Dr. Francis Hornicek, Jr., at UCLA and came to Miami for the chance to do it again.
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Tags: Department of Orthopaedics, Dr. Brooke Crawford, Dr. Francis Hornicek, mentoring, orthopaedic oncology, sarcoma, Sylvester Comprehensive Cancer Center