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  2fI 
-150
1
2fC
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 ?