Derecruitment - La Società Italiana di Neonatologia
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Derecruitment - La Società Italiana di Neonatologia
Quali Tecnologie Disponibili fra Quindici Anni ? Antonio Pedotti SIN – Roma 2012 Trends in Medical Technology : from devices to complex systems Science and engineering drivers: • ICT: computing power, miniaturization, biosensors, connectivity, computational science and modelling support 3 P’S areas: - Pervasive: aims at a semantically integrated platform to access, communicate, process and store health data and knowledge , bioinformatics, eHealth applications, telemedicine, home monitoring. - Personal: aims at services and technologies supporting the individual in personal health (sensors, wearable, adaptive devices, home care etc.). - Personalized: to tune diagnostic and treatment procedures to the individual (multimodal signal and image processing, neural networks, intelligent and interactive devices, etc.). • Regenerative medicine: a more biological approach to the replacement, repair and regeneration of tissues and organs by integration of cells and technology. • Nanotechnology: drug delivery, nanoparticle based therapy, active implants, in vivo imaging. • Biology: merging of life science with physical science and engineering. Prof. Antonio Pedotti Politecnico di Milano Trends in Medical Technology : from devices to complex systems Healthcare 4 P emerging landscapes (by NIH): • Predictive (predictive tools, genome mapping). • Preamptive (better means for prevention). • Personalized (individually tailored intervention). • Participatory (team work, networking, exchange of information). Health care drivers and interacting challenges: • Aging population. • Increased prevalence of chronic degenerative diseases (cardiorespiratory diseases, cancer, diabetes: today 70% of healthcare expenditure is caused by CD). • Constantly expanding scope of what medicine can do. Sustainability of healthcare systems? Challenge for MedTech: is MedTech able to decrease or to contain health care expenditure maintaining or improving the quality of treatments? Consider that in total health expenditures roughly 6% goes to MedTech, 4% health informatics, 10-12% to pharmaceuticals. Prof. Antonio Pedotti Politecnico di Milano Genomics - Bioinformatics Prof. Antonio Pedotti Politecnico di Milano Gene Therapy Prof. Antonio Pedotti Politecnico di Milano Nanomedicine: drug encapsulated in polymer coating for cancer treatment Prof. Antonio Pedotti Politecnico di Milano Nanotechnologies : Metal-based nanospheres + NIR for cancer treatment Prof. Antonio Pedotti Politecnico di Milano Politecnico di Milano Nano-tubes : neural regeneration Politecnico di Milano Applicazioni delle nanotecnologie Information Technology Sistemi computazionali Medicine Energia Tecnologie per energia : Solar Fuel cells Batteries Bio fuels Consumer Goods Tumori packaging, Drug delivery sensors Nuovi farmaci lab-on-chips Test diagnostici stain proof, Imaging textiles Politecnico di Milano Tissue Engineering: integrazione naturale-artificiale Prof. Antonio Pedotti Politecnico di Milano Rigenerative Medicine Prof. Antonio Pedotti Politecnico di Milano Neuron-Silicon Connection Antonio Pedotti Neuroprosthesis 14 Antonio Pedotti Intelligent Machines : Neuroprosthesis (Adaptive Deep Brain Stimulation) •Local Field Potentials (LFP) activity reflects the neuropathological state of the patient •LFPs are modulated by drug administration, movement preparation/execution, electrical stimulation (Deep Brain Stimulation, DBS) Deep Brain Stimulation Stimulation parameters adjustment Analysis of the recorded LFPs LFP filter for stimulation artifact removal LFPs recorded during stimulation Antonio Pedotti DBS is a clinical effective treatment for several neurological and neuropsychiatric disorders (mainly Parkinson disease) Stimulating electrodes are placed in deep brain structures LFP are recorded directly from human subcortical structures and parameters extracted from the signals can be used for more personalized and optimized stimulation Prosthesis A new arm prostheses was designed for an amputee golf player who had a car accident. Movement analysis and a bioengineering based design led to produce an efficient equipment. 1200 Protesi 1 Protesi 2 1000 Back swing 800 Y [mm] Finish 600 400 200 0 -600 -400 -200 0 200 400 600 800 Z [mm] Impact Follow trough Set up Antonio Pedotti Before the accident the player had an handicap 13 , after the amputation and a proper training with the customized prosthesis the handicap was reduced to 8. To date, the player is a third degree golf master and compete in tournament of high level too. IMAGING- MSCT: sensors + computational modelling high speed and resolution, low dose Antonio Pedotti Antonio Pedotti Knee virtual simulator Knee virtual simulator Computer Assisted Surgery and Robotics Advantage: • Great accuracy • 3D Bone Modeling • 3D intra-operative computed planning • Low variability of results • Quantify Error Disadvantage: • Increase time of surgery Detezione lesioni tumorali Antonio Pedotti Broncoscopia virtuale : chirurgia mininvasiva Antonio Pedotti Click to add text Click to edit Master text styles Click to edit Master text styles Second level Second level Third level Third level Fourth level Fourth level Fifth levelz Fifth level PLACE IMAGE HERE Cardiac Pediatric MRI Visionary Techniques. Visible Results. 24 GE Healthcare Discovery MR750w Fctn 2D FIESTA Cine Flow Excellent non-contrast functional assessment ASSET compatible for high temporal resolution LV and RV volume measurement in ReportCard 4.0 Retrospective or prospective gating for patients with normal or arrhythmic heart rate Free-breathing acquisition with multiNEX Cardiac Tissue MR Morph Visualize flow jets in ASD or valve diseases Courtesy: Lucille Packard Children’s Hospital, Stanford University 3D Heart “3D Heart enables the depiction of right dominant coronary arterial system, and this, along with the relatively diminutive left circumflex artery, is helpful in planning a mitral valve repair or replacement.” Dr Shreyas Vasanawala, Stanford University, Palo Alto, CA 6 year old child Right dominant coronary arterial system as seen by continuation of the distal right coronary artery (arrow on left image) to the posterolateral branch supplying the inferior left ventricular wall (arrow on right image). LV Aneurysm is clearly depicted Coronaries & ventricles can be clearly visualized even at high heart rate (HR=85-90 bpm). A 6 year old patient with repaired AV canal defect, mitral regurgitation & LV aneurysm were seen on the MR and the coronary systems were also depicted using free breathing 3D Heart application. The 3D Heart application is a free breathing non-contrast 3D FIESTA with FatSat T2 prep technique that enables clear depiction of the coronaries & cardiac chambers. Multi-slab acquisition enables high SNR & easy prescription. Real-time prospective motion correction is also applied to increase scan Courtesy: efficiency. Lucille Packard Children’s Hospital, Stanfor Prospettive – sviluppi futuri Ultrasuoni Prospettive – sviluppi futuri Ultrasuoni La modalità Fusion Imaging Fusion US/TC - Tiroide Fusion US/RM - Rene Nuove apparecchiature dedicate alla Medicina Generale Interfaccia utente Esame fisico: Ispezione Palpazione Ecoscopio integra l’esame fisico: Visione fluidi peritoneali Visione dimensione organi Percussione Visione posizione & q.tà dei fluidi Auscultazione Visione del cuore ….a livello della superficie Il complemento allo stetoscopio … con un occhio all’interno del corpo Wearable sensors : Home Monitoring and Care 30 Methodologies and technologies development for data collection, analysis and simulation of human-machine-environment interaction Bio-signal … … device 1) Cardio-monitoring ECG and Cardiac Output 2) Breathing pletismography o ECG derived breathing rate 3) Temperature micro-thermometer 4) Others Electrodermal activity, sweat, movements Antonio Pedotti Scientific-technological Breakthrough :Forced Oscillation Technique (FOT) Investigation of structural and functional properties of the respiratory system stimulated by subsonic waves (time-varying small pressures). Advantages: Non-invasive, does not require patient collaboration, accurate and quantitative, suitable for monitoring, uses complex but lowcost technologies easily viable in clinical environment and home. We have recently developed new methods and approach to provide specific and useful measurements for the diagnosis and management of respiratory diseases Antonio Pedotti Expiratory Flow Limitation (EFL) Inspiration Rrs at 5Hz cmH2Osl-1 Volume (l) Expiration Rrs Ca Expiration 1.2 0.8 0.4 0.0 10 8 6 4 2 0 0 Xrs at 5Hz cmH2Osl-1 Caw Expiration Inspiration Inspiration -2 EFL Xinsp DXrs -4 Xexp -6 Ca -8 -10 0 1 2 3 Time (s) 1 Zin = Rrs - j (Caw + Ca)ω EFL 4 5 6 1 Zin = Rrs - j (Caw + Ca)ω DXrs>2.811,2 1) Dellacà et al. Eur Resp J, 2004; Editorial Comments on; 2) Dellacà et al., Eur Resp J, 2007 Antonio Pedotti Ca>>Caw Antonio Pedotti Background Quali possibili ambiti applicativi per questa nuova tecnologia coperta da IP? Forced Oscillation Technique Ventilazione Meccanica Ottimizzazione automatica del livello di PEEP durante la ventilazione meccanica Licenziata in esclusiva a Philips- Respironics in Dicembre 2008 Diagnostica Home Monitoring Sviluppo di un sistema diagnostico per la valutazione della funzionalita’ respiratoria Monitoraggio di pazienti domiciliari in ossigenoterapia e/o ventilati, con l’obiettivo di avere in maniera precisa e semplice dati riproducibili e con l’obiettivo di diagnosticare precocemente l’occorrenza delle riacutizzazioni Licenziata in esclusiva a ViasysCardinalHealth nel periodo 20062009 (4 anni) Antonio Pedotti Resmon- Politecnico di Milano INTELLIGENT MACHINES : Adaptive ventilator for optimisation of alveolar recruitment 80 Overdistension “Safe window” 40 20 Derecruitment 0 0 10 20 30 Optimal MAP 40 Pressure (cmH2O) Collaborations: - Uppsala Universitett, Sweden; - Neonatal ICU, Ospedale di Monza, IT - Università di Milano Bicocca, IT Antonio Pedotti Xrs (cmH2O*s/L) Volume (mL) 60 Overdistension -50 -100 Xrs 2fI -150 1 2fC Derecruitment -200 0 5 10 15 20 25 Pressure (cmH2O) 30 80 Overdistension “Safe window” 40 20 Derecruitment 0 0 5 10 15 20 25 30 Pressure (cmH 2 O) Xrs (cmH2O*s/L) Volume (mL) 60 -50 -100 -150 -200 0 Antonio Pedotti 5 10 15 20 Pressure (cmH2O) 25 30 80 Overdistension “Safe window” 40 20 Derecruitment 0 0 5 10 15 20 25 30 Pressure (cmH 2 O) Xrs (cmH2O*s/L) Volume (mL) 60 -50 -100 -150 -200 0 Antonio Pedotti 5 10 15 20 Pressure (cmH2O) 25 30 80 Overdistension “Safe window” 40 20 Derecruitment 0 0 5 10 15 20 25 30 Pressure (cmH 2 O) Xrs (cmH2O*s/L) Volume (mL) 60 -50 -100 -150 -200 0 Antonio Pedotti 5 10 15 20 Pressure (cmH2O) 25 30 80 Overdistension “Safe window” 40 20 Derecruitment 0 0 5 10 15 20 25 30 Pressure (cmH 2 O) Xrs (cmH2O*s/L) Volume (mL) 60 -50 -100 -150 -200 0 Antonio Pedotti 5 10 15 20 Pressure (cmH2O) 25 30 80 Overdistension “Safe window” 40 20 Derecruitment 0 0 5 10 15 20 25 30 Pressure (cmH 2 O) Xrs (cmH2O*s/L) Volume (mL) 60 -50 -100 -150 -200 0 Antonio Pedotti 5 10 15 20 Pressure (cmH2O) 25 30 80 Overdistension “Safe window” 40 20 Derecruitment 0 0 5 10 15 20 25 30 Pressure (cmH 2 O) Xrs (cmH2O*s/L) Volume (mL) 60 -50 -100 -150 -200 0 Antonio Pedotti 5 10 15 20 Pressure (cmH2O) 25 30 80 Overdistension “Safe window” 40 20 Derecruitment 0 0 5 10 15 20 25 30 Pressure (cmH 2 O) Xrs (cmH2O*s/L) Volume (mL) 60 -50 -100 -150 -200 0 Antonio Pedotti 5 10 15 20 Pressure (cmH2O) 25 30 80 Overdistension “Safe window” 40 20 Derecruitment 0 0 5 10 15 20 25 30 Pressure (cmH 2 O) Xrs (cmH2O*s/L) Volume (mL) 60 -50 -100 -150 -200 0 Antonio Pedotti 5 10 15 20 Pressure (cmH2O) 25 30 Intelligent Machines : Adapive Feedback Ventilator V’ Pressuere Rif Control algorithm Xrs PERSONAL COMPUTER Pao P A LP filter AIRWAY OPENING FLOW AND Acquisition PRESSURE board STIMULUS GENERATOR Antonio Pedotti Telemedicine: home monitoring of respiratory mechanics Aim To study the long-time variability of the lung function in patients with asma and chronic respiratory diseases: 1. To better understand their phatogenesis 2. To identify predictors for the early detection of acute phenomena 3. To optimize the pharmacological and the therapeutic treatment Methods and results GPRS Mobile network GSM UMTS INTERNET Xm-in [cmH2O·s·L-1] Rm-in [cmH2O·s·L-1] Data server 16 14 12 10 8 6 4 2 0 Patient Control 0 -2 Landline or broadband connection -4 -6 -8 -10 0 5 10 15 Day 20 25 30 35 Web access to data server Collaborations: St. Elizabeth Medical Center, Boston, USA Boston University, Boston, USA Antonio Pedotti Trends in Medical Technology : barriers to development Market tightly regulated rules..) (FDA, CE Directives, national Time to market lengthy, costly and risky Fragmentation of Healthcare Systems Acceptance and training of operators Merger and Acquisitions concentration in big players Role of start-ups in innovation Prof. Antonio Pedotti Politecnico di Milano ABOUT FUTURE «It is very difficult to make predictions, particularly when it is about future» Albert Einstein Antonio Pedotti Prospettive – sviluppi futuri Ultrasuoni The next step ?