im3d S.p.A. La Ricerca fa Impresa

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1 im3d S.p.A. La Ricerca fa 26 gennaio 2011 Alberto Bert

2 Outline Introduction CAD COLON CAD BREAST DTS

3 Introduction La Ricerca fa Who we are and what we do The company im3d S.p.A. is a company developing innovative medical imaging solutions for cancer prevention Our research activity started in 2004 with CAD COLON, a joint project with IRCC (Candiolo) As today, CAD COLON has over 50 commercial installations in EU, and is by far the most common Virtual Colonoscopy tool in Italy A second product was launched at RSNA 2010: CAD BREAST DTS, the first commercial CAD system for Breast Tomosynthesis

4 Introduction La Ricerca fa Who we are and what we do The company im3d Clinic started in 2010 to run oncologic screening trials and to offer screening and corporate prevention services, using the im3d technologies In July 2010, the first im3d Clinic Screening Center was inaugurated as a spin-off of the University of Torino

5 Introduction La Ricerca fa Who we are and what we do The company We develop state of the art solutions for the early detection of the main cancer pathologies All our solutions have build in artificial intelligence components (CAD) Behind each of our products there are years of scientific, clinical and software research We translate our know-how technologies (CAD, teleradiology,...) into high quality and efficient screening services

6 Introduction La Ricerca fa Research pipeline im3d Research Project choice Product choice Continuous Innovation New Releases Projects Scouting Basic Research Industrial Research Clinical Validation Outworld Stimuli Proof of concept Prototype Product

7 Introduction La Ricerca fa Research output im3d Research 2 marketed CAD systems 4 pre-market research projects 5 multi-center clinical trials 7 patent applications > 70 scientific communications in national and international congresses and journals > 15 research collaborations with imaging and clinical research groups. Among others: IRCC, Università di Torino, La Sapienza, IEO, AAPM, UC Irvine, Politecnico di Torino

8 Outline Introduction CAD COLON CAD BREAST DTS

9 CAD COLON The impact of colon cancer Colorectal cancer The third most common cancer diagnosed in US The second leading cause of death from cancer Can be prevented by the detection and removal of polyps Levin et al. CA Cancer J Clin. 58: , 2008

10 CAD COLON The exam Virtual colonoscopy Virtual colonoscopy is introduced in 1994 and immediately attracts attention as a possible alternative to optical colonoscopy (OC) Preparation CT Scan Distension 2D images

11 CAD COLON The CAD workflow Our system Digital Cleansing Colon surface extraction Candidate discrimination Candidate segmentation

12 CAD COLON The user interface Our system

13 CAD COLON IMPACT Stand-alone validation Reference standard 11 italian clinical centers Various image acquisition conditions 738 participants at increased risk Reading by two radiologists aware of optical colonoscopy 290 polyps 6mm (124 10mm) Polyps CAD Sensitivity Results Radiologist Sensitivity 6mm 90% 80% 10mm 95% 88% Masses 97% 94% Flat 69% 61% FPs per scan 9

14 CAD COLON CAD-Radiologist interaction Clinical validation? How does the human reader interact with CAD?

15 CAD COLON CADIMPACT Clinical validation Reference standard Sensitivity Polyps # patients Radiologist + CAD Fecal tagging preparation 374 patients at various risk Reading with CAD as a second reader (OC confirm) 79 positives patients (polyps 6mm) 6-9mm 35 57% 71%* 10mm 44 93% 93% 6mm 79 77% 84%* * Statistically significant (p < 0.05) Specificity # patients Radiologist + CAD % 94%

16 CAD COLON Pròteus Screening trial First screening trial ever performed with virtual colonoscopy supported by CAD CAD as a first reader 26,000 average risk subjects invited Integrated in the public healthcare system of 2 Italian Regions(Piemonte and Veneto) Telediagnosis based: distributed image acquisition, centralized (quality monitored) reading

17 Outline Introduction CAD COLON CAD BREAST DTS

18 CAD BREAST DTS The impact of breast cancer Breast cancer The most common cancer in women The second cause of cancer death in women 1.1 milion new cases every year in the world In Italy any women have a 11% (1/11) lifetime risk of developing breast cancer. Breast Cancer Facts &Figures American Cancer Society Inc.

19 CAD BREAST DTS The current technology Mammography The reference examination, both for screening and syntomatic patients Still, has several limitations in terms of sensitivity and specificity Sensitivity: In dense breasts, common in young women (under 50) and a known risk factor, can easily drop under 50%, missing 1 every 2 cancers Specificity: Tissue superposition, due to the breast compression and the 2D nature of the technique, introduces frequent false positives

20 CAD BREAST DTS The next technology Digital breast tomosynthesis A novel 3D imaging technique, where a breast volumetric image is reconstructed, starting from a small set of ultra-low dose mammographic projections The mammographic apparatus is modified to allow the X-ray source to rotate by a small angular range, and to acquire projections at different angles

21 CAD BREAST DTS The 3D step forward Digital breast tomosynthesis

22 CAD BREAST DTS The 3D step forward Digital breast tomosynthesis Clinical studies have proven tomosynthesis to be extremely promising for the solution of the current main mammography limitations.

23 CAD BREAST DTS Tomosynthesis CAD Digital breast tomosynthesis Large number of images (slices) for each breast, potentially increasing the radiologist reading time and chances of perceptual errors Advantages determined by CAD are expected both in reading speed and in sensitivity CAD BREAST DTS, launched at RSNA 2010, is the first commercial tomosynthesis CAD system

24 Quali tesi? Partecipazione all attività di ricerca legata al disegno, implementazione e validazione di algoritmi per sistemi reali di supporto alla diagnostica oncologica, in stretta collaborazione con i ricercatori im3d (image processing, pattern recognition, analisi dati, programmazione, ricerca bibliografica e brevettuale, pubblicazioni, ecc.) Partecipazione alla conduzione di studi di validazione clinica di innovative tecniche diagnostiche e sistemi di supporto alla diagnosi in ambito oncologico, in stretta collaborazione con i ricercatori im3d (analisi statistica dei dati, gestione dei dati, ricerca bibliografica, pubblicazioni, ecc.)

25 Contatti Alberto Bert Head of Research im3d S.p.A.

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