La Médecine de Precision soutenue par l’IAjficv.com/usrfile/Presentation/2019/SYM01-P01.pdf · GEHC Europe 2019 Live Broadcast l 28 January 2019 l Confidential. Not to be copied,

Abdelaziz LAOUAR, PhDMedical Innovation Manager, Western Europe

GE Healthcare

La Médecine de Precision soutenue par l’IA

Document confidential. Diffusion et production interdites.24/10/2019 2

Precision Medicine

Conventional TherapyConventional Therapy

Patient A Patient B

Histology:Malignant Tumor

Molecular Analysis:HER2-positive

Molecular Analysis:HER2-negative

HerceptinHerceptin

Rezi

div

-fre

ies

Überl

eben Cx.. +

Herceptin

only Cx.

Jahre

Molecular Analysis for Decision Making in Breast Cancer

Histology:Malignant Tumor

GEHC Europe 2019 Live Broadcast l 28 January 2019 l Confidential. Not to be copied, distributed or reproduced without prior approval.

PATIENTS

RADIOLOGISTS

CLINICIANS

C-SUITES

GOVERNMENTS/PAYERS

MED TECH SUPPLIERS

Value based medicine driven by clinical outcomes with patient incenter…

Changing roles of healthcare stakeholders

DATA, MOBILITY, COST SENSITIVITY, TRANSPARENCY

TODAY/TOMORROW

Precision Health enabled by AI

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Precision Medicine


Precision Medicine

Document confidential. Diffusion et production interdites. 7

Precision Medicine

TO

FROM

PRECISION MONITORINGPRECISION DIAGNOSTICS

In-Vivo + In-Vitro

Protocol driven

Highly personalized

Precisely targeted clinical trials

Complex processes simplified. Precision interventions. Additive

Pro-active approach to wellness beyond the hospital

Costly and risky R&D

Complex and unguided

Patients only monitored when sick

Decision Making Therapy Innovation

Each patient... digitally connected

Therapy Delivery Monitoring

Integrated, longitudinal, fueled by AI

Too much data, in toomany different places

PRECISION THERAPEUTICS

Precision Health GE Healthcare

Confidential. Not to be copied, distributed, or reproduced without prior approval.

In-Vivo + In-Vitro Decision Making Therapy Innovation Therapy Delivery Monitoring

Precision Diagnostics Precision TherapeuticsPrecision

Monitoring

In-Vivo Diagnostics

In-Vitro Diagnostics

Clinical Decisions

Operational Decisions

Supply Chain

Image Guided Tx

Additive

Care Pathways

Research

Clinical Development

Technology PlatformsLeading platforms for delivering digital healthcare solutions

•Cloud•Edge•AI

With our partners, a leading portfolio of solutions that improve outcomes in priority care pathways

•Cardiology

•Oncology

•Women’s Health

•Neuro & Ortho

Acute

Mobile / Tele / Remote

Population Health

GE HealthcareIntelligence Suite C

yber

9

Strategicpartnership with

Cerebro

Buildingtowards

5 Feb 2019Enabling Precision Health

Precision Health

Confidential and internal. Not to be copied, distributed, or reproduced without prior approval.

Decision Making Therapy Innovation Therapy DeliveryIn-Vivo + In-Vitro Monitoring

Precision Diagnostics Precision Therapeutics Precision Monitoring

Protocol driven Too much data, in too many different places

Costly and risky R&D Complex and unguided Patients only monitored when sick

From

Highly personalized Integrated, longitudinal,fueled by AI

Precisely targetedclinical trials

Complex processes simplified. Precision

interventions. Additive

Pro-active approach to wellness beyond the

hospital

To

Each patient ... digitally connected

ExampleGE Healthcaresolutions Cerebro®

for Alzheimer’sLiver

ASSIST VI

Cardiac Ambulatory Suite

Oncologyand Acute Care

CommandCenter

MRAIRx

VenueShock Toolkit

10

The precision health journey


Q: How is GE accelerating its delivery of Precision Health? A: We’re partnering with leading innovators

11

… and many more

Clinical Partners Technology PartnersPharma/Medtech Leaders

5 Feb 2019Enabling Precision Health

Confidential. Not to be copied, distributed, or reproduced without prior approval. Roche-GE Collaboration 12

Partnering to build Tumor Board 2.0Convergence of NAVIFY and CENTRICITY Collaboration Suite platforms

GE CENTRICITY Collaboration Suite

PATIENT CASES

COORDINATOR

RADIOLOGIST

PATHOLOGIST

ONCOLOGIST CARDIOLOGIST

SURGEON

Organize and run cross-specialty sessions with centralized access to patient images and case data.

•Zero-Footprint Viewer (ZFP)•MDT preparation & administrative tools •Report templates

2017 20202018 2019

Workflow Products

NAVIFYTM Platform

Decision Support Apps (incl. AI)

Aggregated Data Insights

Growing portfolio of workflow and clinical decision support solutions

•Improved & adaptive workflow for multiple clinicians•Data driven patient and disease information to improve personalized patient care

ROCHE NAVIFY


Precison Health

INTERACT Active Tracker active la synchronisation automatique des images entre les volumes U/S et CBCT 3D volumes, même lorsque le tracker est situé en périphérie du volume 3D.

Bénéfices :

Tracker détecté électromagnétiquement même lorsqu'il est situé à l'extérieur du volume CBCT, ce qui permet une couverture par imagerie plus flexible du patient.

Processus de fusion simple: détection transparente et automatiquedu tracker dans les volumes CBCT,transfert réseau vers LOGIQ E10, traitement automatisé du volume et co-enregistrement

Résultats : •Améliorer la productivité en RI,

•Tirer profit du CBCT comme un pont pour enregistrer l’Ultrasons

avec n'importe quelle image pré-op, même si acquis sans tracker, en utilisant la fusion multi-modalité sur AW•Améliorer la visualisation des lésions et le guidage de l'aiguille

en utilisant une grande variété d'images

Volume NavigationINTERACT Active Tracker

15

Traitement : Planification et Guidage

eTrax– Sécuriser le geste grâce au guidage virtuel

o Un capteur ré-utilisable permet de visualiser la pointe de l’aiguille à l’intérieur du patient

o Visualiser la trajectoire de l’aiguille et sa position exacte

o Guider des biopsies dans le plan et en dehors du plan de l’écho de façon plus rapide et plus sûre

o Prévoir et suivre le déroulement des interventions en synchronisation d’images avec des données fusionnées en temps réel

Guidage virtuel d’aiguille avec coaxial

Réel suivi de l’aiguille

Peut aider à réduire le nombre de redirection lors des procédures et donc l’essaimage de

cellules

Vivid E95

16

Understanding the Procedures

Vivid, cSound, XDclear, HDlive, EchoPAC, and ViewPoint are trademarks of General Electric Company.

Planning phase is key to the success of implanting the device specific to that patients anatomy

PLAN

Precisely position the device can be challenging and has an impact on regurgitations

GUIDE

Device deployment assessment & assessment of regurgitations

ASSESS

17Confidential. Not to be copied, distributed, or reproduced without prior approval.

Interventionel 17

Cardiologie:

Discovery IGS 730 & Vivid E95

Vivid CT FusionValve ASSIST 2

NEW

Sites: CHU Lille / CHU Rennes / CHU Toulouse / Cl Pasteur (Toulouse)

Congrès: SFCTCV (Rennes) juin; PCR – London Valve (nov)

Centricity™ Cardio EnterpriseMUSE™ Cardiology Information System

Precision Health and Aortic Stenosis

MAC2000Vivid™E95

Vivid s5StressEcho

Case exercisetesting

Discovery™IGS 730

ValveASSIST

2

Visipaque™&

Omnipaque™

Vivid E95 +Echo-Pac

MAC 5500 ECG

Revolution &Cardiographe

CT

Choose treatment based on valve function, severity of

symptoms and surgical risk

Plan procedure, best prosthetic match, based on

aorta and valve anatomy

Assess valve position and function after deployment, including fusion imaging

Screen for AS with ECG and echocardiogram

Monitor prosthetic valve hemodynamic status and detect

complications


Monitoring

In-Vivo + In-Vitro Decision making Therapy innovation

Therapy delivery Monitoring

Vivid E95 with Mitral

Valve Assess

Vivid4D

TEE

Revolution™ &Cardio-

Graphe CT

AW™TAVI

Analysis

GE PUPLIC

Precision Health and Stroke Care

Centricity™ Cardio EnterpriseMUSE™ Cardiology Information System

LOGIQ™ & Vscan™Ultrasound

IGS 630 Interventional

X-ray

Revolution™ CT &FastStroke CT

Application

Carescape™VC150

Algorithm Server+ ECG

recorders

Signa™ Premier MR Fast Brain protocol, 48

channel head coil

Visipaque™MR & CT Contrast agents

GRC Research

project

Venue™ultrasound &

AW FastShock

Accurate planning, rapid

lesionaccess, precise

assessment

Simplifies and organizes CT images for fast evaluation of

Stroke patients

Vital Signs Monitoroffering

seamless EMR connectivity

Accurate lesion confirmation and risk factor determination for 2° Prevention

Isosmolar contrast agent

Researching new

technologies for pre-hospital diagnosis

Simple, Fast, precise

diagnosis of shock


Monitoring

In-Vivo + In-Vitro Decision making Therapy innovation

Therapy delivery Monitoring

GE PUPLIC

• Preeclampsia is one of the leading causes of maternal and perinatal death worldwide and affects 2-5% of all pregnancies. It’s a frightening condition because it can come on suddenly and progress quickly

Clinical Innovation – Preeclampsia risk

Voluson imaging + ViewPoint 6 clinical algorithm

= Risk of Preeclampsia Precision Health

+ Biochemistry

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Precision Medicine & AI

Avalanche of data in healthcare

Fast and furious

Numbers5 KB / record

Text500 KB / record

2D Images1,500 KB / image

3D Images35,000 KB / study

Ultrasound20,000 KB / waveform

Video5,000,000 KB / movie

Hi-Res202, 375,168 KB / genome

New

Dat

a

TraditionalData

Growing at

48% per year2

of data per hospital150 Petabytes

1. “The Digital Universe Driving Data Growth in Healthcare,” published by EMC with research and analysis from IDC (12/13) 2. The upside of disruption, Megatrends shaping 2016 and beyond - EY

Document confidential. Diffusion et production interdites.

50 Pétabytes=

8 000 000 000 de livres=

533 fois la Bibliothèque Nationale de France

- Internal use only -

Must be stored for 5-25 years(average 10 years)

EB/ globally

5-25

IDC Health Insights, 2017

which is …

1024 Petabytes1,048,576 Terabytes

1,073,741,824 Gigabytes1,099,511,627,776 Megabytes

Exabyte1

~4.5


Why an Industrial Revolution | An Infinite AI Space

https://wsrs.org/2018meeting/handouts/allen_ai.pdf

• Physics• Anatomy• Function (fMR)• Pre/intra/post scan• Genomics• …

10987654321

1

0

9

8

7

6

5

4

3

2

1

Timeliness

Cost


Better computing

power

Availabilityof large

data sets

Better algorithms

Cloudservices

“In just seven years, the winning accuracy in classifying objects in the dataset rose from 71.8% to 97.3% surpassing human abilities and effectively proving that bigger data leads to better decisions.”

“AI is more important than fire...” Sundar Pichai, Google CEO, 2018

How an Industrial Revolution | Enter Deep Learning

72% 75%85% 88%

94% 97%

2010 2011 2012 2013 2014 2015

Be designed for the benefit, safety and privacy of the patient

Be a trustedsteward of thedata and insights

Be transparent and deliver robust and reproducible results

Guard againstcreating orreinforcing bias

GE HealthcareAI PrinciplesGE Healthcare will apply these AI principles to help improvehealthcare quality, cost, access and the patient experience,in the pursuit of Precision Health. AI Systems exist toaugment human intelligence, elevate clinicalcare teams and must:

Begin the Revolutionwith Values

Checklists/Metrics to Consider | Do you have the Volume?

Essential, but not sufficient

• Volume increases performance

• Volume must be “balanced”

• Annotation can drive volume needs

Checklists/Metrics to Consider | Do you have the Variety?

Variety prevents brittle AI

• DL models are data driven

• If only one data source is used, the model is likely “brittle” and not generalizable

• We’ve found # hospitals > data volume

• Seek diversity = geo, depart, vendor, socio/eco…

FoV Variability

Positioning Variability

Contrast Variability

Variety drives generalizability

Document confidential. Diffusion et production interdites.

a) Nouvelles applications, développées par GE Healthcare et nos partenaires cliniques.

b) Plus de 50 applications intelligentes déjà disponibles, couvrant les thématiques clinique, opérationnelles et financières.

34

a) Nouveaux ispositifs médicaux intelligents conçus pour améliore les workflows, la producivités, les diagnostics, et plus encore.

b) Possibilité de mettre à niveau certains dispositifs médicaux existants pour en augmenter les bénéfices.

• Imaging InsightsAn Edison application

Edison Platform

a) Permet aux équipes R&D de GE

Healthcare et à nos partenaires

stratégiques de concevoir, développer,

gérer, sécuriser et distribuer leurs

algorithmes et services rapidement.

b) Intègre un catalogue étoffé de services

de développement spécifiques pour la

santé.

c) Compatible avec tout modèle de

déploiement et d’exploitation : Cloud, on

Premise, embarqué.

Edison Smart DevicesEdison Applications

R&DDispositifs médicauxApplications

• OPTIMA XR240amxPowered by Edison

Edison | Create an AI factory that embraces everyone

Deployment TargetsData Source

2 Industrial Scale

AI and analytics in the healthcare system

Individuallevel

Enterprise level

Departmentlevel

Edison | Seamlessly embed AI in medical devices: X-Ray

Intended Benefit: Designed to deliver greater efficiency and better integrate technologists and radiologists

X-Ray technologist & care team alerted

*510(k) pending at US FDA. Not available for sale in the United States.

Why: Quickly identify and help prioritize critical cases such as Pneumothorax

Intended Benefit: Pneumothorax identification – designed to achieve high accuracy with (AUC >0.95)

Intended Benefit: AI point of care identification has the potential to expedite review by a radiologist of the critical findings.

On-screen notification & prioritization

Results sent to PACS

What: AI injected into device for real-time point of care support

2 Industrial Scale

38Confidential. Not to be copied, distributed, or reproduced without prior approval.

Interventionel 38

Liver ASSIST V.I.

Une solution complete pour:

-identifier les tumeurs

-Identifier les vaisseaux nourriciers

-prédire les différentes strategies d’embolization

Jusqu’à 97% de sensibilité dans l’identification des vaisseaux nourriciers, réduction de 11% du temps de procédure1 , et 68% de taux de réponse complète de la tumeur (vs 34% en DSA seule)

Simulation des embolisations en temps reel avant le traitementLiver ASSIST V.I. développé sur Edison

apporte une approche prédictive de l’interventionnel !

NEW

Edison | Seamlessly embed AI in medical devices: WH U/S

Benefit: Consistent measurements and significant workflow efficiency. (0:00-0:10)

Benefit: Prior to execution of the algorithm the users still possess ability to confirm placement. (Users really like this level of control)

Benefit: The system automatically acquires the required scans and measurements with precision every time.

User guides system to the fetal brain

Acquires accurate volume measurement, plans next scans

System executes the scans and final measurements

SonoCNS can help reduce keystrokes by 77%.

Enhancing user productivity and experience over time

2 Industrial Scale

Edison | Seamlessly embed AI in medical devices: MRMR AIRx™

Intended Benefit: Precise slice placement resulting in fast, consistent scanning

Rapidly identify Anatomical Landmarks

Intended Benefit: Consistent and accurate scans regardless of patient position, time between scans or technologist

Reduce rescans and workflow inefficiencies

https://medium.com/tensorflow/intelligent-scanning-using-deep-learning-for-mri-36dd620882c4

2 Industrial Scale

AIRx™ is Not Licensed in Accordance with Canadian Law. Not CE marked. Not available for sale in all regions.

Powered by a deep learning algorithm created from a database of 36,000 images

© 2018 General Electric Co.Advanced Visualization Applications for GE CT |

Bone VCARFirst GE CT deep-learning (DL) post-processing application

Algorithm tested on a database of 900+ different exams from a wide range of countries, scanner models and acquisition profiles:

•Different vertebrae coverage: cervical, thoracic, full spine…

•Different kV settings: 80, 100, 120, 140

•Different image kernel – standard, SOFT, DETAIL, BONE, BONEPLUS…

•Normal and abnormal datasets (see table)

Success Rate: 94.5% (test database)

97% (training database)

Examples With anomaly

Without anomaly

Artefacts Spinal implant, Bone cement, Dental artefacts, Beam hardening, low dose

103 389

Shape of the spine

Kyphosis, Scoliosis, Lordosis,

spondylolisthesis, patient posture

141 353

Shape of

the disc(s)

Herniated disc,

degenerative disc

149 349

Shape of the vertebra(e)

Osteophyte/arthritis, fracture, compressed fracture, spondylolysis

132 366

Density of the vertebra(e)

Osteoporosis, metastasis, bone cement

89 414

Anatomical variation

Lumbarization, sacralization, atrophied ribs

37 470

510(k) pending at FDA. Not available for sale in the United States.Not yet CE marked, not available for sale in all regions.

NEW

© 2018 General Electric Co.

Trusted results – provides highly accurate auto-processing of DICOM non-contrast head CT images using artificial intelligence for prioritization and triage of brain bleed

Powerful simplicity – auto-returns real-time, case-level signal and summary page to the CT scanner or PACS/RIS system stating if a suspected hemorrhage has been found

AbsoluteZero™ – zero clicks to initiate, zero need to leave the workflow, zero stored PHI, zero change to the images

Rigorously tested

Class II FDA-cleared medical device; CE approved; PHI compliant

Included with any GE Smart Subscription*

Advanced Visualization Applications for GE CT |

Accipio IxIdentify and triage NEW

Accipio Ix and AbsoluteZero are trademarks of MaxQ-AI. GE Healthcare is a licensed distributor of Accipio Ix.*Technologies in development that represent ongoing research and development efforts. This offering may not become a permanent offering and/or may not contain the products and its functionalities described herein

© 2018 General Electric Co.

From FBP to Iterative Reconstrucion thanks to Deep Learnin

1972 – 2008 The Era of

filtered back projection (FBP)

2008 – 2018The Era of

Iterative Reconstruction (IR)

2018 – FutureThe Era of

Deep Learning Image Reconstruction

Robust, fast and gold standard image quality at higher dose

Higher image noise and artifacts in low dose settings [1,2]

Maintain image quality while reducing the dose by up to 82% (vs high dose FBP)

Unfamiliar image texture produced by full strength IR. [1,2]

Achieve outstanding image definition, natural image texture, and low dose, all at

the same time.


Sagittal T2 FRFSERapid acq : 1 NEX

58sec

Sagittal T2 FRFSERapid acq : 1 NEX

58secDLRecon

Technology in development. Not cleared or approved by any regulatory body for commercial availability.

- Internal use only -Technology in development. Not cleared or approved by any regulatory body for commercial availability.

MR Excellence: Reducing patient waiting time for MR without sacrificing clinical quality

03:58

02:20

01:38

02:54

04:56

03:15

02:55

03:36

-16% -1mn56s

Dr. Christopher Ahlers Managing Partner, radiomed

Estimated 260,000 € per year per machine benefit*Reduced patient waiting time from 6 to 2 weeks for certain exam

types

Optimize a protocol for efficiency

Before After

BEFORE AFTER

MR1.5T – Cervical Spine example

Cannot sacrifice the clinical outcome

Proven and Improved Workflow

Average Number of exams/week

+46exams/week126

jan.-17

Initial phase

172

mar.-17

Final phase

feb.-17

146

Sag T2

frFSE Sag

T1 FSE Cor

STIR

Ax T2 frFSE

Ax Cube T2

* - Using patient public reimbursement rate in Germany. Results listed here are of this specific customer and may not be typical. Results are based on factors specific to

each customer. GE cannot guarantee these or similar results.

Command Center: Transforming clinical operations through artificial & human intelligence

8%increase in

daily ED Visits1

45%reduction in

inpatient clean bed waiting

time2

23equivalent

beds added3

Predictive analytics and systems engineering to better managepatient safety, experience, volume, and movement of patients.

GE plans to announce 10 new command centers covering 30 different hospitals—which, over five years should yield those medical centers a roughly 4 to 1 ROI.

1. CIHI NACRS ED Activity Reporting, 2. HRH Housekeeping System Data Extracts, 3. CIHI DAD Inpatient Reporting, Acute Conservable Bed Days

Humber River Hospital, Toronto, Canada


Takeaways:

Our customers have to start tackling their data.

[Data quality – Data management – Data analytics]


Rapid development ...

2020 2027 2032

Deep Learning algorithms will be able to create reports for mammography and chest x-ray exams.

CT of the head, chest, abdomen, and pelvis; MR of the head, knee, and shoulder; and ultrasound of the liver, thyroid, and carotids.

Within 15 to 20 years, deep-learning algorithms will be able to produce reports for most diagnostic imaging studies.

Dr. Bradley Erickson, PhD, from the Mayo Clinic, Rochester, MN. May 25th 2017, panel discussion at the U.S. National Cancer Institute (NCI) Shady Grove Campus in Rockville, MD.


+

… or Man w/ Machine vs Man w/o Machine.

Geoffrey Hinton

“You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete.”

– Buckminster Fuller

Documents

La Médecine de Precision soutenue par l’IAjficv.com/usrfile/Presentation/2019/SYM01-P01.pdf · GEHC Europe 2019 Live Broadcast l 28 January 2019 l Confidential. Not to be copied,