Discussing the future in healthcare innovation : telehealth, robotics, diagnostics & devices, wearables and behavioral health.

Pondering on the convergence of industries remodeling conventional corporate thinking leading to innovation beyond.

  • Nuclear medicine, an exploding market April 12, 2018

    Nuclear Medicine, an exploding market

    A convergence of factors will accelerate the boom in nuclear medicine in the coming years, according to many experts in the field.

    Nuclear medicine allows to (almost) non-invasively diagnose and/or treat many illnesses and conditions, hence its advantage vs other medical protocols such as biopsies and surgeries. In short it can be defined as a branch of radiology, which deals with the administration of radioactive substances to a patient either for diagnostic or treatment purposes. The multidisciplinary nature of nuclear medicine (involving physicians, chemists, engineers, physicists) makes tracing its origins somewhat challenging. One thing for sure, we can safely say that it is after the discovery of radioactivity by Henri Becquerel in 1896! The term “isotope” (meaning “same place”) was coined by Frederick Soddy in 1913.

    Typically in interventional nuclear medicine, a beta particle emitting radioisotope is administered to the patient and the short range ionizing property of the radiation destroys the targeted diseased tissue. Iodine-131 for example, is used in the treatment of thyroid cancer and hyperthyroidism. Compared to conventional radiotherapy, such treatments can be conducted as outpatient procedures, because of the much reduced side effects and lightness of the procedure.

    In a typical diagnostic scenario, an organ specific ligand is attached to a gamma ray emitting radionuclide, and the resulting radiopharmaceutical injected in the body. The resulting image is that of the tracer’s distribution in the body hence resulting in a functional image of the targeted organ or tissue, as opposed to an anatomical image from conventional imaging techniques such as MRI or CT scans. Hybrid scanning techniques give the best of both worlds, superimposing e.g. a CT and a PET scan image.

    These hybrid imaging techniques allow physicians to visualize anatomy and physiology simultaneously on the same image. Although these images measure more parameters single modality techniques, they still provide a static picture. A new triunal imaging technique, combining PET-CT-UUI modalities (ultrafast ultrasound imaging) is able to capture thousands of images per second in 3D, hence enabling the capture of dynamic phenomena. Such combined imaging modalities is one of the convergence factors promoting the coming boom in nuclear medicine.

    Artificial Intelligence is another factor. Gartner, a consultancy, deemed 2018 the year of AI Democratization. AI is used to tackle one of medical imaging’s biggest challenge: image processing. First, the sheer (and growing) amount of data to analyse makes AI an obvious choice. AI also alleviates human cognitive biases, which can lead to erroneous diagnostics. AI can even be used upstream to first construct high quality images with fewer data points. This use of AI results in the added benefit that patients need be exposed to lesser doses of radiation and undergo shorter scans.

    New tracing agents are continuously designed, e.g. for brain scans, making diagnoses and treatment assessments ever more precise and efficient. New, improved protocols using existing agents and technologies are being developed to achieve the same goals of better patient outcome. Specialized hardware, from microchips to supercomputers, are being designed specifically for medical imaging purposes.

    Nuclear medicine is also becoming a key component of population health in many different ways. Imaging data, for instance, can be used along with other data to help establish better population health management strategies. Another example is the Sterile Insect Technique which plays a vital role is controlling vector driven diseases such as Dengue or Zika.

    These are some of the factors combining together to grow the nuclear medicine and radiopharmaceuticals market at an impressive CAGR of almost 10% in the next few years to over USD 9 Billion in 2023, according to a recent report, a big part of which coming from AI, according to a PwC report.

    Finally, did you know that there is a connection between clouds (the ones in the sky, not the computing one), lightning and nuclear medicine? Find out here.

    As always, comments, questions, feedback are welcome.

  • Improving patient outcome with hammers and nails ? September 11, 2017

    At some point, healthcare has to be delivered to the patient. Ok, preventative healthcare and a healthy lifestyle do not require you to physically meet with your physician, but e.g. surgery still does. So we still need hospital buildings. Hence, buildings themselves are an integral part of the healthcare ecosystem and as such, contribute just as much to patient outcome as does the procedure performed on the patient. Welcome to the great world of healthcare architecture.

    It is a recognized fact that a patient’s overall wellbeing significantly contributes to his/her faster recovery. Hence patient-centric designs for hospitals, making them look and feel more like hotels than the traditional neon-light, bleach-white cubic edifice. This is not a new idea, as exemplified by the Architecture of an Asylum exhibition at Washington’s National Building Museum. But healthcare architecture is much more than just nice designs. It addresses many of the challenges that healthcare faces. Evidence-based design is now used by architects and engineers, helping them take into account even the smallest details such as replacing metal handles by wooden ones, the former oftentimes aggravating the neuropathic hands of patients undergoing chemotherapy

    Infection control and prevention in hospital settings is a major concern, especially given the increase in multidrug-resistant organisms. The fight against infectious pathogens in hospitals from the architectural angle is precisely what Wolfgang Sunder, in charge of the KARMIN project at InfectControl2020, is doing: “When it comes to the structural level, one specific issue is what a room needs to look like to counteract the spread of pathogens: what size should it be? Does it require specific building equipment and ventilation technology? What materials do we need to use? How can surfaces be cleaned and disinfected? These are some of the questions we need to ask, which is also why we see an urgent need for research in this area.”

    Achieving a patient-centric environment is one thing. This must however not be done at the expense of caregivers’ workplace ergonomy. In other words, a hospital needs to remain functional for the nursing staff. Far from being a balancing act only achievable through compromises on both sides, innovative solutions can be implemented that will answer to everyone’s needs and even go beyond. Mehrdad Yazdani, design director of CannonDesign’s Yazdani Studio, created sculptural headwalls for patients’ rooms, behind which medical equipment can be hidden from the patient. As a bonus, these removable panels allow hospitals to easily upgrade their equipment as technology evolves.

    Another such many-problem-solving-at-once example is AIA COTE Top Ten award winning NTFGH hospital, in Singapore. Through its use of natural ventilation and passive cooling, patients have their own operable window, providing them with sunlight and a view. In addition of being more energy efficient than mechanical air conditioning, it saves water, since no cooling towers are required, making the hospital a greener corporate citizen who abides by many of the seven elements of a climate friendly hospital, as edicted by the WHO.

    Healthcare architecture extends well beyond the science and technology required to achieve better patient outcome. It also takes into account the social fabric of the community in which the hospital is established and to which healthcare services are dispensed. Karratha Healthcare Center, in Australia, was designed from the start with these considerations in mind : “Our briefing and design responded to the cultural values of Indigenous clients [and] the understanding of cultural traditions for privacy” says Coda, the firm commissioned as the project lead, in a design statement. Neighbourcare Health, in Seattle, WA, which won an AIA Healthcare Design Award, offers spaces to neighbourghood groups after hours. Its patios can double as consulting spaces for mental health homeless patients and the driveway is wide enough to provide space for farmers markets.

    This brief account all but scratches the surface of what architecture can contribute to healthcare. For one, we focused on hospitals. Healthcare architectural concepts obviously apply to medical clinics, retirement homes, research labs and even private homes as well. And if we were to ask health authorities, they would certainly say everything we build should be designed with healthcare in mind, since everything we build has an impact on public health e.g. air quality in buildings, fire hazards in high-rises, etc.

    The integration of architecture and healthcare begins way before the groundbreaking ceremony and even before the first sketches of the design firm. It is a way of thinking that starts with education. This is the philosophy driving the merger between Thomas Jefferson University, with its roots in medicine, and Philadelphia University, with its roots in arts, business and engineering, from which graduates will emerge with a symbiotic knowledge between healthcare and architecture.

    To get an idea of some of the best healthcare architecture projects, take a look at Contract magazine’s Healthcare Environment Awards, AIA/AAH Healthcare Design Awards, or World Interior of the Year Awards shortlist, which is this year dominated by China, including the Health&Education category.

    As always, comments, questions, feedback are welcome.

  • Skip the hospital and get a 4D-bioprinter ! February 14, 2017


    3D printing is often referred to by the term additive manufacturing, because of the way objects are printed (layer by layer). The term rapid prototyping is also used since, as the name says, it is a means of quickly producing a three-dimensional object. Invented in the 1980s and originally called stereolithograpy, the ever expanding field of 3D printing offers much more than just a way of rapidely achieving three-dimensional mock-ups. As it applies to life science, 3D bioprinting is the process of creating complex structures that mimic original tissues and organs using 3D-printing technologies, where cell function and viability are preserved within the printed construct.

    In its simplest (and earliest) health care applications, 3D printers make three-dimensional models of organs to be used before and during surgeries, for planning and execution. Prosthetics can also be 3D-printed, allowing customization much more easily. An English firm is even offering a 3D-printed wheelchair, which it says can be taylored to fit the individual needs of a wide range of disabilities and lifestyles.

    Another very promising area of application is personalized pharmacy, where pills are 3D-printed to the specifications of the patient’s pharmacist like e.g. drug release profile, dosage, even color and geometry. Errors in medication accounting for thousands of deaths each year in the US alone, such a way of producing patient-specific medication has the potential of significantly reduding this number.

    All those applications, as useful and interesting as they are, are not bioprinting per se, since none involve the production of biological contructs. Bioprinting has its own specific challenges. To name but a few, printing devices and methodologies have to take into account the sensitivity of living cells, the biomaterial being printed (the bioink) has to first be available in a printable state―obviously. Regulatory issues need also be addressed. These additional complexities can and are being overcome, and are offset by the immense advantages 3D-bioprinting promises.

    Clinical trials and drug testing can be long, complicated and costly processes. Using 3D-printed human or human-like tissues can greatly simplify these endeavors. No (or less) cultural or ethical issues are involved, and no subjects need be recruited to undergo studies

    Body implants, made of foreign material, can be toxic and cause rejection, whereas 3D-bioprinting provides organic implants which, as with 3D-printed prosthetics, can be shaped individually and with precision, based on MRI and CT scans images.

    Regenerative medicine is another obvious area of application. Rejection rates are lower and success of surgery is higher when tissue built from the patient’s cells himself are used to 3D-bioprint the implanted tissue. Together with the lower cost of 3D-printing the tissue itself, the overall cost to the healthcare system can be greatly reduced. Skin, bone, cartilage, teeth, even complete organs like a heart can be 3D-printed. Yet another advantage is that the possibility of “manufacturing” tissues and organs helps alleviate the difficulty of finding compatible donors for transplants. 22 people die each day while waiting for a transplant in the US.

    As very briefly described, 3D-bioprinting promises to disrupt health care in many and yet unknown ways. But the next step is already being taken : 4D-bioprinting, where the 4th dimension is transformation. It is the 3D-printing of smart, stimuli-responsive biomaterials to create constructs that emulate the dynamics processes of biological tissues and organs. Imagine for instance that, instead of having to 3D-print a skin graft for a burn victim, with all the entailed complexity, you could 4D-print a basic skin graft that would, once implanted on the patient, vascularize itself, develop all nerve endings, take on the patients complexion, and even grow hair if on the head ? In a way, 4D-bioprinting is to medicine what AI is to computer science.

    Are we on our way to making 4D-bioprinting synonymous with procreation ?

    As always, comments, questions, feedback are welcome.

  • Taking the measure of made-to-measure medicine March 24, 2016



    Pharmacogenomics, pharmacogenetics, precision medicine, personalized medicine : terms often used interchangeably to talk about the tailoring of treatment to individual patients based on their uniqueness. Actually, pharmacogenomics/genetics uses the genetic profile of the patient whereas precision/personalized medicine looks at other probable causes as well, such as environmental factors, lifestyle behavior, physiology, epigenetic data, the microbiota.

    The idea of precision medicine is that different individuals are subject to different diseases and react differently to medical treatments. Hence, each person should adopt a different lifestyle in order to prevent illness and should get tailored treatments should they become sick.

    Part of the challenge resides in the amount data that need be first collected and then processed, in order to achieve meaningful and efficient tailoring of medical treatment. The genome of a single individual has 3 billion base pairs and 20K genes; its microbiota consists of more microorganisms than it has human cells; environmental factors, lifestyle behaviors and the like are virtually unlimited. In short, pertinent data can rapidly grow to astronomical proportions. And the rate at which data is produced will soon outweigh the rate of progress in computing and big data technology. Moreover, this data needs to be exchanged amongst healthcare practitioners, and it needs to do so securely.

    Another part of the challenge is the science itself. On the genetic front, there still exists significant gaps in the sequencing of the human genome, and only a low fraction of known disease causing genes lie in high confidence regions i.e. “easily sequencable” chromosome regions. And on the mental illness side of the story, so little is known about brain functions that even a fully decode genome would be of little help.

    Even as a means of prevention, pharmacogenomics has work to do : research shows that even when informed about genetic predisposition to disease, people a not likely to modify their health behavior.

    In cases for which precision medicine does work, it remains a high-tech, expensive business. To the point that it is advocated by some that it is not worth it. Obviously, this is not the dominating opinion: President Obama recently celebrated the first year of his Precision Medicine Initiative, and Roche is investing up to $1B in a precision medicine company, to name a few examples.

    On a lighter note, if precision medicine turn out not to deliver on its promises, it will at least be useful for singles to find love, as GenePartner.com claims. And once you found your match, Orion Health will tell you if he or she will be faithful to you.

    You can read further about precision medicine, its ethical implications, and market predictions .

    As always, comments, questions, feedback are welcome.

  • When virtual realities reshape patient realities ! February 16, 2016

    brain circuitry

    Virtual reality (VR) is becoming mainstream. This year was coined “year of the VR” at CES. VR headsets are now available at your local electronics store. Although it has been used for healthcare purposes for many years, use of VR in healthcare still cannot be qualified as generalized or widespread. However, VR is rapidly expanding into the healthcare realm and, according to a recent Global Industry Analysts report, the global VR healthcare market will be reaching US$ 3.8 billion by 2020.

    Currently, a main focus of VR applications in healthcare is in the treatment of fear related disorders such as Dr. Cornelius Gross, deputy head of EMBL Monterotondo, explained in a 2014 EMBL Insight Lecture, it is easier to recognize and compare fear than it is other emotions.

    Indeed, VR provide safe, private, controllable environments for exposure therapy, on the most efficient methods for treating phobias. Since, by definition, VR environments are fully controllable (as opposed to exposure in the “real” world) it provides a secure set up for the patient undergoing treatment that can be customized to his or her specific needs with a few mouse clicks, and is private i.e. keeps the patient’s treatment confidential. Another important advantage of VR is that, exposure therapy requiring repeated sessions, it is more cost effective than in vivo exposure therapy.

    Augmented reality (AR), a more cost effective version of VR, and can oftentimes be just as effective as VR. In AR, the subject is put in a real world environment, but aided with an AR device such as the Google Glass. In some cases, AR is even the better solution over VR.

    VR is also used for training purposes. Just as for patient treatment, VR provides a safe, controllable environment in which healthcare professionals can learn and practice skills for which it would be difficult or even dangerous to do so in vivo: who would want to be a heart surgeon’s first patient ?

    Other areas where VR is used include pain management, treatment of PTSD, phantom limb pain, brain injury assessment and rehab, social cognition training and more.

    In many instances where VR is used, the brain is the source of the problem being treated. VR and other cognitive behavioral therapies offer efficient, non invasive diagnosis and treatment possibilities, the full potential of which is far having been reached.

    Other promising methods of treating phobias, for example, include optogenetics, whereby a simple beam of light is used to selectively and very precisely activate or deactivate the neurons implicated in triggering the phobia, as demonstrated in mice by Pr. Christine Denny, at Columbia University Medical Center. But this is another subject.

    You can read further about how VR is used in training, treating phobias, or optogenetics.

    As always, comments, questions, feedback are welcome.

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