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ThomasLangøAct.ResearchManager,PhD,ChiefScientist,MedicalTechnology-SINTEF
Coordinator,NorwegianNationalAdvisoryUnitforUltrasoundandImage-GuidedTherapy-St.Olavshospital
DetdigitaliserespåmangenivåEtliteblikkinniinnovasjoner
Medisinskteknologi
HelsepolitiskseminariMidt-Norge,3.desember2018
TrondheimMedTechcluster:Cross-disciplinary
collaborationonclinicaldecisionsupport(since1995)
NorwegianNationalAdvisoryUnitforUltrasoundandImage-GuidedTherapyAclosecollaborationbetweencliniciansandtechnologicalresearchscientists
INDUSTRYProductdevelopmentandtheapplicationofresearchresults
HOSPITALSandUNIVERSITIES
Basicresearchandeducation
SINTEFMultidisciplinaryapplied
contractresearch
www.usigt.org
Evolutionintherapy
Increasedneedforimagingandguidancetechnology
ThebestwaytopredictthefutureistoCREATEit-AbrahamLincoln/PeterDrucker
Technologyforabettersociety
2µm
Differing responses to scientific discovery by various sectors
TIME
Rat
e of
Cha
nge
Society
Business
Sector
Technology
Healthcare
Thefutureisnotwhatitusedtobe-YogiBerra
Teknologiforetbedresamfunn
U.S.physiciansper10,000people,1850-2009,Wikipedia
Moderntechnology…?
Doctors/patients
Teknologiforetbedresamfunn
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Trendsshapingfuturehealthcare
Technologyforabettersociety
2µm
Pasientens helsetjeneste…
1996
2017
GUnsgård,OSolheim,TSelbekketal.
Intraoperative navigation platform for research and development in image-guided interventions
CustusX Open source platform for R&D (since Jan 2015)
www.custusx.orgAskeland C et al. CustusX: An open source research platform for image guided therapy. IJCARS, 2015.
LOGO
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Norwegian Centre for Minimally Invasive Image Guided Therapy and Medical Technologies
Norwegian Centre for Minimally Invasive Image Guided Therapy and Medical Technologies
Visuell profil for NorMIT
Areasofclinicaluse,testing,ordevelopment• Neurosurgery
• Vasculardiagnostics• Endovasculartherapy
• Laparoscopicsurgery
• Bronchoscopy• Anaesthesia
• ENTprocedures• Trainingandsimulation
• Orthopaedics• Spineinterventions• HIFU/MRgFUS
• Localablation
• Guidinginjectionsandbiopsies
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Navigation in bronchoscopy
Multimodal navigation in endobronchial ultrasound
SamplingtissuefromlymphnodewithEBUS-TBNAtoinvestigateforcancerspreadImagefromCustusXnavigationplatform,SINTEF/USIGT.SegmentedairwaysfromCT(green),PET(red/orange)andultrasound(lowerrightimage)Upperright:CTwithultrasoundsector,lymphnode(red)andtumor(yellow).CourtesyHåkonO.Leira,St.OlavsHospitalandNTNUandErlendF.Hofstad,SINTEF/USIGT
Mariana-LungnavigationRankedasbestproposal!
• Steerableandtraceablecatheter(Deep-Reach)-Netherlands
• High-precisionelectromagnetictracking(Deep-Track)-Ireland
• AIandcloudbasedimageguidance(Deep-View)-SINTEF/Ceetron
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AI:automaticprocessingofdataRobotics:assistingtheclinician
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ArtificialIntelligence
NarrowAIistheonlyformofArtificialIntelligencethathumanityhasachievedsofar
GeneralAI,alsoknownashuman-levelAIorstrongAI,isthetypeofAIthatcanunderstandandreasonitsenvironmentasahumanwould
WhenAIbecomesmuchsmarterthanthebesthumanbrainsinpracticallyeveryfield,we’veachievedArtificialSuperIntelligence
Artificialintelligence(Machinelearning->Deeplearning)
ImageNetLargeScaleVisualRecognitionChallenge(ILSVRC)
UsingDeeplearning
ImageNetErrorrate
http://image-net.org/index
Deeplearningvshumansandstate-of-the-artmethods
LitjensGetal.Asurveyondeeplearninginmedicalimageanalysis.MedicalImageAnalysis42(2017)60–88
bonesuppressioninx-rays
mammographicmassclassification
segmentationoflesionsinthebrain
leakdetectioninairwaytreesegmentation
diabeticretinopathyclassification
prostatesegmentation
noduleclassification
breastcancermetastasesdetectioninlymphnodes
humanexpertperformanceinskinlesionclassification
AIandMachineintelligenceisnotreplacingbutassistingmedicalexperts:AIplusphysicianisbetterthanphysicianorAIalone
Real-timeannotationofultrasoundimages(BiimultrasoundAS,St.Olavhospital,SINTEF,fundedbyForskningsrådet)
• Assistphysicianinultrasoundimageinterpretation• Mainfocusonnerveblocksandvascularaccess• Convolutionalneuralnetworkwithmanuallyannotatedtrainingdata• Runningonmobileunits
Red=Artery Green/Blue/Yellow/Pink:Nervesintheaxillaregion
Machinelearninginsepsis
-havinganearlywarningsystemandbeingabletouseittoalterclinicalcarearetwodifferentchallenges…
TREWScorehasonlybeenvalidatedtomeasuredetectionperformanceandhasnotbeenevaluatedforitsabilitytoaffecttherapeuticjudgement
KEHenry,DNHager,PJPronovostandSSaria.Atargetedreal-timeearlywarningscore(TREWScore)forsepticshock.ScienceTranslationalMedicine05Aug2015:Vol.7,Issue299,pp.299ra122DOI:10.1126/scitranslmed.aab3719 https://www.youtube.com/watch?v=Nj2YSLPn6OY
AIinSepsis
BrukekunnskapenfraalletidligerepasienteribehandlingenavDENNE
World largest genotyped sepsis cohort• 26 years follow up
(1994-2018)• Cases (>3000) and
controls (>65000)• Electronic Health
Records• HUNT data with risk
factors, genetics, blood, serum
• Mid-Norway Sepsis Registry
• Microbes (~5000)
Decisionsupportsystems
Earlydetection,warning,prediction
GeminisenterSepsisforskning
Dagenspraksis PresisjonsmedisinGeminisenterSepsisforskning
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CarlJørgenArum,Urologi,St.Olavs
•ESWLproblem:✦ 50%avESWLenergymisses✦ Kidneymoveswithbreathing(severalcm)✦ Focalpointforenergydepositis~1cm✦ 30-40%ofESWLpatientsneedseveraltreatments✦ (15-20%ofPCNLandURSneedseveraltreatments)
AI(deeplearning)andultrasoundtooptimizekidneystonetherapy
SebastienMüller,SINTEF/NTNU
Developmentofmachinelearningalgorithmsinprognosticationofbreastcancer(PhDproject)
BiomarkersquantifiedquicklyusingautomatedsegmentationalgorithmsinQuPath(OpenSourceDigitalPathology)
• goalistoestablishautomateddigitalbiomarkerannotationsystemsandtodevelopmachinelearningalgorithmsforimprovedbreastcancerprognosticationinordertostratifypatientswithbreastcancerintoreliableprognosticgroups
PhDfundedbySamarbeidsorganetfrom2019
AIinDigitalpathology
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InfrastructuresforAIreseachinmedicine
HUNTCloud
Annotationweb,datafortraining
LOGO
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Norwegian Centre for Minimally Invasive Image Guided Therapy and Medical Technologies
Norwegian Centre for Minimally Invasive Image Guided Therapy and Medical Technologies
Visuell profil for NorMIT
Tromsø
Trondheim
BergenOslo
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Cognitiverobotics Additivetechnologies(enabling)
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CanAImakeaDoctorbetter?
Yes,ifthetechnology:
1)Eradicatewaitingtime2)Prioritizemyemails3)FindmetheinformationIneed4)Keepmeup-to-date5)WorkwhenIdon’t6)Helpmemakeharddecisionsrational7)Helppatientswithurgentmattersreachme8)Helpmeimproveovertime9)Helpmecollaboratemore10)Doadministrativework
Technologyforabettersociety