Category: Endoscopy

We have so many immersive experiences today that transport us to a reality that existed in dreams and fantasies earlier. Welcome to the world of Virtual Reality (VR). As the name suggests, it’s virtual and yet the experience is meant to feel real. A computer-simulated alternate world that you experience with sensory devices such as handsets and gloves.

Then there is Augmented Reality (AR), here the focus is the real world and there are digital elements superimposed. One of the best examples of this is in the Ikea Place app. If you wanted to see how an IKEA sofa looked in your living room, you just tap the product and use your phone camera to place the digital sofa in your living room to see how it looked.

 

So how does all of this fit into healthcare? Let’s check out some of the interesting applications in use.

In gastroenterology, the use of AR in the endoscopic unit helps improve the polyp detection rate, polyp classification, polyp size estimation, etc. Key to the AR technology is image processing and computer vision. Image processing allows the deconstruction of the image captured as a part of the input (camera) into a series of parameters and properties. The computer vision refers to the high-level image processing which allows the computer to interpret the image or series of images.

AED4EU is an app that uses AR to show all known Automated External Defibrillators in the location near you. AED4EU will also give you the phone number and address.

AccuVein uses augmented reality by using a handheld scanner over the skin and shows nurses and doctors where veins are in the patients’ bodies. It’s been used on more than 10 million patients, making finding a vein on the first stick 3.5x more likely.

These are just a few applications putting AR to good use in healthcare. Let us round up the overall benefits of AR and VR in medicine as it potentially promises to revolutionize treatment, therapy, training, and education.

1. Surgical Simulation, Training, and Education

Virtual Reality transports you directly inside the human body to access in 3D view even the tiniest of veins that otherwise would be impossible to see. Currently, medical students learn on cadavers, which are difficult to source and do not react as live patients would. In VR however, you can view minute details of the body in a 360° CGI (Computer-generated imagery) reconstruction & create training scenarios that could substitute common surgical procedures.

Case Western Reserve University and the Cleveland Clinic have partnered with Microsoft to develop a HoloLens app called HoloAnatomy to visualize the human body in an easy and spectacular way.

With Microsoft’s HoloLens Headset, app users are able to see everything from muscles to veins before their eyes through a holographic model. This has the potential to revolutionize medical education.

 

Specialized training simulators can be created to improve surgeons’ skills in various scenarios. Simulated models help many surgeons, plan, and rehearse before the actual surgery, as a part of preoperative planning. These virtual models of the patients’ bodies can be made using the MRI, CT, and Ultrasound scans.

Such simulators can also be used by trainee residents and students in developing intuition and decision-making abilities.

AR enables experienced surgeons to remotely assist residents by using an Internet connection and therefore opens the way of excellent distant teaching. Compared to virtual reality (VR) simulators, where the whole simulation takes part in a CG (Computer-generated) environment, the main advantage of AR simulators is the ability to combine real-life objects with CG images, resulting in satisfactory tactile feedback.

By monitoring and transmitting the image of a surgical site between two distant stations, remote virtual collaboration is possible between two surgeons. This concept is sometimes referred to as “telepresence”. A VIPAR ( Virtual Interactive Presence Augmented Reality) system was used in an effort to allow communication between Vietnam and the USA.

Another interesting example of immersive training experience is the HumanSim system which enables doctors, nurses, and other medical personnel to interact with patients in an interactive virtual training environment. This measures the participant’s emotions via a series of sensors. Helps the medical professionals to develop more empathy for patients among other things.

2. Virtual reality diagnostics

Virtual reality is often used as a diagnostic tool in that it enables doctors to arrive at a diagnosis in conjunction with other methods such as MRI scans. This removes the need for invasive procedures or surgery.

3. Virtual robotic surgery

A popular use of VR is in robotic surgery. This is where surgery is performed by means of a robotic device that is controlled by a human surgeon, which reduces the time and risk of complications. The robotic device is accurate, meaning smaller incisions, reduced blood loss, and faster recovery.

Robotic-assisted surgery with Da Vinci surgical systems are cleared by applicable regulatory agencies for use in a number of different procedures such as colorectal, cardiac, urology, general surgery, gynecological, head and neck, and thoracic.

4. Treatment of phobias, anxiety disorders, and addiction

Combined with biosensors that monitor physiological reactions like heart rate and perspiration, therapists can assess how patients react to stressful situations in a safe, virtual environment. This is applied to the treatment of post-traumatic stress disorders and patients with various phobias.

VR can also be a useful tool to treat addicts and prevent a relapse from occurring by exposing them to the right stimuli.

VR can help people with autism develop social and communication skills. It can also diagnose patients with visual or cognitive disabilities, by tracking eye movement.

5. Patient Education

The ability to view the inside of the human body in Virtual Reality is not only useful for doctors, but also for patients. VR allows patients to be taken through their surgical plan by virtually stepping into a patient-specific 360° VR reconstruction of their bodily anatomy. This helps them in the understanding of the treatment.

6. Pain Management & Physical Therapy

VR’s healing capabilities are used in physical therapy and pain management too. UW Harborview Burn Centre uses the VR game, Snow World, to alleviate the pain for burn victims during wound care. VR distracts the mind from the source of pain and immerses the patients in an alternate world of snowmen, snowballs, and penguins.

VR for physical therapy has also been shown to be effective in speeding recovery. Allowing the patient to do their prescribed daily exercises in a virtual environment makes the activity more fun, keeps them in high spirits during a long recovery period. Today, we also have the option of having a digital physiotherapist at home by means of a VR avatar.

Future Trends and Challenges

The adoption of AR and VR in healthcare is forecast to grow even more quickly, with the value of the market increasing by 38% annually until 2025.

However, there are challenges in the mainstream adoption of these technologies.

► Cost is definitely one of the factors. These technologies are expensive. A lot of big investors like Google and Facebook have pumped billions into the VR market, allowing for some very powerful hardware like the Oculus Quest to hit the market. The total cost of ownership of the technology solutions will need to be contained if it is to be adopted widely.

► Mobility is another challenge. One of the biggest limiting factors with current technology is the need for restricting headsets, display units, and all the cords used to connect them. However, hardware devices have started to trend towards being “untethered”. Facebook’s Oculus headset that initially needed to be connected to a powerful PC, became available as the self-contained Oculus Quest version.

► VR requires higher bandwidths and superfast networks. 5G will open up new possibilities for these technologies. Data transfer speed of 3 gigabytes per second (as opposed to 100mbps for home broadband) would be required to stream data from the cloud. Rather than needing to be connected to PCs, viewing devices will upload tracking data to data centers on the cloud where the heavy processing will be done. The rendered images can be delivered back to the user in real-time thanks to the speed of 5G and other advanced networks.

► Lack of knowledge and research around AR/VR in health care. A quick search of research studies shows over 3,536 publications with “virtual reality” or “augmented reality” or “mixed reality” in the title since 1991. Unless there is more knowledge and useful research available, mainstream adoption will be slow.

► Regulatory/Policy/Insurance issues. As with anything new in healthcare, unless there is wide adoption of this technology, regulatory and insurance challenges will be a given.

As Facebook, Google, Oculus, Samsung, and Sony continue to aggressively market VR/AR experiences for consumers, more people will be exposed to it and interest will grow. That said, patient demand and pull will have a powerful influence on administrative and clinical decision-makers.

Healthcare facilities from across the globe are now utilizing immersive applications such as vein visualization, surgical visualization, etc. Development-driven healthcare professionals are researching areas that could potentially benefit both customers and businesses. While some of the hospitals are not equipped to handle these technological advances, many of them (including third party companies) are choosing to invest in the same.

A lot of the VR and AR applications mentioned above are still in their infancy. However, the potential for VR in the healthcare sector is huge, limited only by the imagination and insight of those creating and applying the technology.

 

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Originally published on LinkedIn, by Suzette Sugathan, Director, NextServices
Image Credit: Pexels.com

 

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From printing food to organs, 3D printing is a fascinating exponential tech industry in the making. This week we shall delve into its application in healthcare.

In this article, you’ll understand where the opportunities are in this upcoming field.

• What is 3D printing?
• Bioprinting and its uses in regenerative medicine 
• Other applications of 3D printing in healthcare
• Current challenges and future of this promising technology

To put it simply, 3D printing is a process of making 3D solid objects from a digital file. It’s an additive process, wherein an object is created by adding layer after layer of material. Until finally the desired object takes shape.

3D printing in healthcare: Four core areas

As per the report published by Allied Market Research, the global 3D printing healthcare market accounted for $972.6 million in 2018. It is expected to reach $3.69 billion by 2026, growing at a CAGR of 18.2% from 2019 to 2026. Here are the four major areas.

1. Bioprinting tissues and organoids (grow from stem cells)

2. Manufacturing customized medical and dental devices

3. Manufacturing surgical tools

4. Producing patient-specific anatomical models

► 1. Bioprinting tissues and organs

Bioprinters are 3D printers with one key difference. Instead of using materials such as plastic or metal, these printers deposit layers of biomaterial. That means these printers use cells to build living tissues. That eventually become blood vessels, bones, heart, or skin.

In the early 2000s, researchers discovered that living cells could be sprayed through the nozzles of inkjet printers. That didn’t damage the cells. But the problem was cells need a nurturing environment to stay alive: food, water, and oxygen. Such an environment is made possible by a micro gel that has vitamins, proteins, and other nourishing compounds. Researchers plant the cells around 3-D printed scaffolds made of biodegradable polymers or collagen so they can grow into a fully functional tissue.

For example, this method could be used to “print” a bladder, a simple organ consisting of only two types of cells. Here are the steps:

a) Scan a patient’s organ to determine size and shape

b) Create a 3D model from the scans

c) Using degradable polymer, print scaffolds to help cells grow in 3D

d) Place the organ in the patient’s body

e) Watch the scaffold slowly disappear after surgery

Isn’t it fascinating? There’s more.

In a landmark achievement, Tel Aviv University has 3D printed a small heart using human tissue. While the organ itself is smaller than one would need in a transplant, it is a massive step forward for bioprinting. Here the bio-inks used were “personalized hydrogel”, extracted from the fatty tissues of the human test patients.

 

Bioprinted bones are made with a durable and regenerative biomaterial capable of fusing with a patient’s natural bones over time. Eventually being replaced by them.

Researchers in South Korea developed 3D printed artificial corneas. Meanwhile, an Australian bio fabrication center called BioFAB3D built a handheld cartilage printing device called the BioPen. The BioPen is filled with stem cells derived from a patient’s fat. That helps in creating and implanting custom scaffolds of living material into failing joints.

Wake Forest School of Medicine has designed a printer that can print skin cells directly on to a burn wound.

Bioprinting also has its uses in clinical trials. It can use 3D printed tissues and organs without conducting trials on animals. Loreal, the French cosmetics major, partnered with 3D bioprinting company Organovo to 3D print human skin. This helps test their products before they get to market.

As this amazing area evolves, organ donations will be a thing of the past. The space of regenerative medicine will bring hope to many people around the globe.

You could even be printing your own personalized medicines soon. The possibilities are truly exciting.

► 2. Manufacturing customized medical and dental devices

3D printing has made manufacturing of medical devices less complex, much faster, more cost-effective, more customized, and easier to sterilize.

Prosthetics – 3D printing has completely transformed the prosthetics industry. Now you have perfectly fitted devices that are more cost-effective as well as functional.

 

Surgical guides – Both dental and medical surgeries require precision. A 3D printed surgical guide can help a surgeon line up holes, incisions, and implants as per the patient’s anatomy. Now with 3D printing, these guides can be produced rapidly to specifications.

 

Implants – 3D printing produces fine mesh structures at no additional cost. The organic structure of the device reduces the risk of rejection after the surgery is complete. These customizable implants are usually manufactured with 3D metal printing. This makes them strong, sterile, and matched to the patient’s needs.This is a test done on a sample of blood. It looks for cancer cells from a tumor that are circulating in the blood or for proteins in the blood due to the response of the immune system to the cancer. This will help in detecting cancer at an early stage.

► 3. 3D printing surgical tools

Sterile surgical instruments, such as forceps, hemostats, scalpel handles, and clamps, can be produced using 3D printers.

Not only does 3D printing produce sterile tools, but some printers based on origami, allow for the printing of tools that are precise and small in size. These instruments can be used to operate on tiny areas without causing unnecessary extra damage to the patient.

► 4. Preparing patient-specific surgical models

Creating 3D anatomical models from CT scans or MRIs is becoming increasingly useful for both doctors and patients. While these models help doctors prepare for their complex surgeries, they serve to educate patients about procedures. This helps not just reduce patient anxiety and recovery times but improves pre-operative planning and operating room efficiency. 

Source: https://formlabs.com/blog/3d-printing-in-medicine-healthcare

In the words of Dr. Alexis Dang, an orthopedic surgeon at the University of California San Francisco (UCSF) and the San Francisco Veteran’s Affairs Medical Center:

“Every one of our full-time orthopedic surgeons and nearly all of our part-time surgeons have utilized 3D printed models for care of patients at the San Francisco VA. We’ve all seen that 3D printing improves performance on game day.”

These 3D printed models are also widely used for training. For example, 3D printed endoscopic biopsy simulators are practical and useful tools in endoscopic training.

Three challenges before 3D printing goes mainstream in healthcare

As you can imagine, a regulatory and legal framework is still in the works. The scope for 3D printing is vast – from drugs and biologics to implants and prosthetics.

Beyond regulatory challenges, there are several technical challenges to overcome. These include costs of equipment, biocompatible materials, and interoperability between software and hardware.

Finally, there’s the economic hurdle of getting paid from insurance companies. While an FDA-approved 3D-printed joint implant may be reimbursed, 3D models of a patient’s anatomy and professional fees often are not.

Crossing these hurdles paves the way for the future.

3D printing in healthcare: At the cusp of an exponential curve

Consider these areas where 3D printing can be a gamechanger.

◘ A typical kidney transplant can cost more than $300,000. 3D printing has the potential to reduce that number to less than $100,000.

◘ Almost 114,000 people in the U.S. are on the waiting list for a life-saving organ donation. 3D printed organs can eliminate these queues forever.

◘ There are nearly 2 million people in the United States with amputations. 3D printed prosthetics can get people back in motion faster than ever before.

◘ The average price of a set of surgical instruments today is more than $3,000. This cost can reduce dramatically with 3D printing.

◘ A multihospital organization can have more than 25,000 pieces of equipment. 3D printing has a big role to play here.

Emerging opportunities for business and impacting people’s lives are aplenty here. Add the power of customization and precision, you can see the power of this exponential technology.

If you are in healthcare and be a part of this transformation, the time to experiment is now.

 

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Originally published on LinkedIn, by Suzette Sugathan, Director, NextServices
Image Credit: Unsplash.com, Rob Wingate

 

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COVID-19: The Way Forward for Gastroenterology Practices
COVID-19 is a double whammy of both clinical and business disruption. This ebook will help you explore possible scenarios and be a guide in your plans for the future.