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

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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