The Smart Magazine About Medical Technology Innovations
MEDICA & RSNA Special Issue
This new edition explores two major medical trade shows that marked the end of the year: MEDICA, held in Düsseldorf from November 13-16, and the RSNA conference in Chicago from Nov 26-Dec 1.
Artificial intelligence with ever more sophisticated algorithms was a key topic at both events. Another focus was the increased use of 3D printing in healthcare. We’re also offering you a taste of some of the most innovative products presented at the fairs, including a non-invasive treatment for benign tumors, a virtual reality massage chair and an easy-to-use blood test that indicates risks for stomach cancer.
Artificial intelligence (AI) was a key topic at both MEDICA and the RSNA conference this year. But what are its applications in healthcare in general and radiology in particular? And what are the barriers? Dr. Michael Forsting, director of the Institute of Diagnostic and Interventional Radiology and Neuroradiology at...
The RSNA‘s most recent challenge highlights the potential of machine learning in radiology. The goal? To develop an algorithm for accurately determining bone age from pediatric hand radiographs.
This year’s annual RSNA meeting focused on how artificial intelligence and machine learning (ML) can aid radiologists and other imaging professionals. In this context, the society’s high-profile Pediatric Bone Age Challenge ran from August to October under the auspices of the group’s Radiology Informatics Committee (RIC). Keenly contested, the challenge called on participants to develop an algorithm for accurately determining bone age using X-rays of children’s hands.
The bone age of a child indicates the level of biological and skeletal maturity, and is typically used in the evaluation of endocrine and metabolic disorders.
“The participating teams were judged by how well their algorithm-derived bone age evaluations matched the evaluations of expert human observers,” explained leading radiologist Dr. Adam Flanders, chairman of the RIC. “The results were both surprising and exciting.”
Will Radiologists Follow the Dodo?
The challenge’s top 20 algorithmic results surpassed the accuracy of all previous evaluations of this type.
“We’re now talking accuracy to within one hundredth of one percent of the human evaluations.”
“These algorithms are becoming more and more sophisticated,” said Flanders. “We’re now talking accuracy to within one hundredth of one percent of the human evaluations.” Such results make it clear that computer-aided radiological diagnosis will soon incorporate hugely complex and incredibly accurate ML algorithms. Some fear this could make radiologists obsolete.
But Dr. Flanders believes such fears are unfounded. “This technology is not about replacing humans, but helping radiologists do their job more efficiently. ML-empowered devices could be hugely effective tools for precision medicine. By saving time and by allowing radiologists to focus on doing other things better, they could raise the bar for the entire discipline.”
What You Can’t See…
In fact, radiological algorithms simply compare image pixels. By doing so logically and mathematically, they can see things that are imperceptible to humans. “They can see trends, relationships that we might miss,” says Flanders.
Algorithms may also help diagnose problems in parts of the world where there is no access to a radiologist. “Take the villages of sub-Saharan Africa,” says Flanders. “It is here that a reliable, portable, networked algorithm-based device could be used as a life-changing first step in diagnosis.”
The challenge’s top 20 algorithmic results surpassed the accuracy of all previous evaluations of this type (Courtesy of RSNA)
Dr. Jonathan Morris, a diagnostic and interventional neuroradiologist, is co-director of the 3D printing laboratory at the world-renowned Mayo Clinic, and chairman of the 3D Printing Special Interest Group of the Radiological Society of North America (RSNA). We caught up with him to discuss the rise of 3D printing in...
French echotherapy specialist Theraclion presented its flagship Echopulse device at this year’s RSNA. It combines an ultrasound imaging system with high-intensity focused ultrasound (HIFU) therapy. The latter destroys benign breast and thyroid tumors non-invasively, painlessly and with precision. The next step will be to treat cancerous tumors. Theraclion CEO David Caumartin told us more.
MedicalExpo e-magazine: Echopulse was created in 2004. Why has it taken so long to develop this technology?
David Caumartin: We responded to a request by Saint-Louis Hospital in Paris for a way to use focused ultrasound as an alternative to head and neck surgery. Following CE certification for thyroid and breast treatment, we sold the first Echopulse in Germany in 2013. It took a while to develop such complex technology because it requires complicated studies and takes time to reach the market. Introducing a non-surgical alternative to surgery runs into a lot of resistance. Today, we have 36 systems in use around the world, half of them in Germany. We also have four clinical research systems in the United States.
At this year’s RSNA, a University of Virginia (UVA) team was invited to present data from the preliminary feasibility study. They used Echopulse on 20 patients, and followed them for 12 months. After the study, Theraclion approached the Food and Drug Administration to begin a pivotal study in the US to evaluate the safety and efficacy of Echopulse. UVA is managing the study and recruitment is already at nearly 50%. In the trials, 100 patients will be followed for 12 months. The goal is to enter the American market in a year and a half.
ME e-mag: How does the system work?
David Caumartin: The robotic system positions a treatment echograph over the lesion. It then performs thermal ablation by sending heat generated by high-intensity ultrasound waves through the skin and healthy tissue to the tumor.
“The biggest difference compared to other systems is its remarkable precision.”
The patient receives a local anesthetic and the treatment head is positioned precisely over the center of the tumor via the user interface controls. The robot automatically makes a 3D map of the tumor, enabling the operator to determine tumor volume from several cross-sections. The system then locates target zones on the cross-sections and destroys the tumor one point at a time. The doctor simply makes sure the treatment is proceeding properly. The system is designed to operate automatically.
The heat destroys the DNA of the tumor cells. This cellular destruction incites the immune system to clean away the dead cells and the tumor in general. The immune response is not immediate. The tumor begins to shrink after several weeks. Generally, one month out we see a 10% reduction in the tumor volume. At three months, the reduction is between 30 and 50%, At six months, 50-70%, and 80-90% after a year. In nine of 10 cases, one treatment suffices.
ME e-mag: Are you treating only benign tumors for the moment?
David Caumartin: Our CE authorization only covers benign tumors—breast fibroadenomas and benign hot and cold thyroid nodules. There are two possibilities for broadening clinical use. The first is extending treatment to other benign thyroid conditions, especially autoimmune diseases in which the thyroid overproduces hormones. A pivotal study covering this is underway at Hong Kong University.
The second, more interesting possibility is to include breast cancer. This is under study at the University of Virginia. We had to take the benign tumor treatment route to legitimize the work and to understand the operative mechanisms of tumor size reduction in order to know how to position the technology for the treatment of cancerous tumors.
“One of the possibilities for broadening clinical use is to include breast cancer.”
ME e-mag: What are the most innovative aspects of your system compared to other ultrasound devices?
David Caumartin: Ours is the only one capable of breast and thyroid treatment. It was designed for ease of use by surgeons, without need for a radiologist or an operating room.
The biggest difference compared to other systems is its remarkable precision—down to one millimeter. This is necessary to treat thyroid tumors because centimeter precision would be too risky. When treating cancerous lesions, systems like radiotherapy destroy everything around the tumor. Our system is not only non-invasive but also very precise.
ME e-mag: Are there any side-effects like burns or pain?
David Caumartin: Neither the skin nor the areas around the tumor are burned. You must be careful with nearby nerves because they are more heat-sensitive than other cells. But our instructions make it clear how to do this. There’s no need for painkillers after treatment and it’s also very rapid; a typical treatment lasts 30 to 40 minutes.
Medisana‘s virtual reality massage chair was a highlight of the 2017 MEDICA trade fair. The innovative product is aimed at individual consumers and healthcare professionals.
According to Medisana, virtual reality (VR) dates back to the first flight simulator in 1920. A century later, the technology is found in many healthcare applications, from pain reduction to surgical planning using real-world interactions. And that’s exactly what the VR massage chair is based on.
“It combines a massage chair with a VR system, creating a state of deeper immersion. It incorporates visual and audio media such as 360° videos of cities or beautiful environments, as well as fantastic, never-before-seen computer-generated views,” explained Anja Schimmelpfennig, Medisana marketing director. The main goal is to let the user dive into a virtual world, isolating him/her from surrounding sources of stress and anxiety.
Medisana provides both the chair and the headset, into which the user places his/her smartphone. A free app delivers the visual and audio contents. It instructs the massage chair to execute a program individually designed for each VR experience. The app communicates with the chair via a wireless Bluetooth interface.
Combining massage and virtual reality (Courtesy of Medisana)
The chair provides different types of massage—Shiatsu and tapping in both the back and the seat, and rolling and vibration massage in the seat. There is also an optional heat function.
A New Level of Massage Intensity
“This combination of multiple technologies supported by an online platform is definitely something never seen before,” emphasized Schimmelpfennig. She even suggested this constitutes a “revolution” in massage. “By successfully separating the user from outside influences, it enhances the positive, relaxing and recreational potential of a massage.”
This could offer consumers more ways to reach a new level of massage intensity. “We believe that we can dramatically enhance the user experience of today’s standard massage devices,” added Schimmelpfennig.
While the product is mainly intended for individual consumers, the technology provides a way to implement VR and massage in the healthcare environment. Medisana claimed that the numerous possible applications could help treat “patients suffering from stress and anxiety, […] patients with dementia or undergoing radiation and chemo therapy, and many other purposes.”
Another interesting innovation presented at MEDICA was the GastroPanel quick test. This diagnostic blood test provides valuable information on stomach conditions almost immediately, and can predict risks for stomach cancer.
“The GastroPanel quick test is a unique combination of four biomarkers. You can get a lot of information about the condition of the stomach which otherwise would be very difficult to obtain,” explained Ilari Patrakka in an interview with MedicalExpo e-magazine. Patrakka is marketing and sales director at BIOHIT Healthcare, the Finnish manufacturer.
The test helps diagnose Helicobacter pylori infection. More importantly, it identifies people with atrophic gastritis, a risk factor for stomach cancer. “It’s a real screening test for the risk of stomach cancer,” said Patrakka. Several long-term studies consistently show that these risk factors are highly reliable predictors of gastric cancer, even 15 years before onset.
The test also estimates the risk of developing vitamin B12 and micronutrient deficiency. A normal test result indicates that your stomach is basically healthy, suggesting that the gastric symptoms might be functional or related to other causes.
Over 90% Accuracy
“The test has shown to be very accurate—over 90%,” continued Patrakka.
The GastroPanel quick test (Courtesy of MEDICA)
In addition, the test is very easy to use. It can be performed during a single clinical visit using a drop of blood from the finger. Results are available in just 15 minutes. Patrakka said that this saves costs and unnecessary clinical appointments, as well as speeding referrals for further examination and treatment.
“It can be used by general practitioners in the doctor’s office. It really is a point-of-care tool,” he added. It also could be used in the field in developing countries, where Helicobacter pylori infection seems to be more prevalent. According to the Mayo Clinic, these bacteria may be passed from person to person through direct contact with saliva, vomit or fecal matter. They also may be spread through contaminated food or water. Risk factors for H. pylori infection are related to living conditions during childhood—a crowded home, lack of a reliable supply of clean water, living in a developing country or living with someone with an H. pylori infection.
“GastroPanel quick test will be available in Europe as soon as the CE IVD certification process is completed,” said Pattraka.