Quali Tecnologie Disponibili fra Quindici Anni?

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1 Quali Tecnologie Disponibili fra Quindici Anni? SIN Roma 2012 Antonio Pedotti

2 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

3 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

4 Genomics - Bioinformatics Prof. Antonio Pedotti Politecnico di Milano

5 Gene Therapy Prof. Antonio Pedotti Politecnico di Milano

6 Nanomedicine: drug encapsulated in polymer coating for cancer treatment Prof. Antonio Pedotti Politecnico di Milano

7 Nanotechnologies : Metal-based nanospheres + NIR for cancer treatment Prof. Antonio Pedotti Politecnico di Milano

8 Politecnico di Milano

9 Nano-tubes : neural regeneration Politecnico di Milano

10 Applicazioni delle nanotecnologie Information Technology Medicine Sistemi computazionali Tumori Drug delivery Nuovi farmaci Test diagnostici Imaging Energia Tecnologie per energia : Solar Fuel cells Batteries Bio fuels Consumer Goods packaging, sensors lab-on-chips stain proof, textiles Politecnico di Milano

11 Tissue Engineering: integrazione naturale-artificiale Prof. Antonio Pedotti Politecnico di Milano

12 Rigenerative Medicine Prof. Antonio Pedotti Politecnico di Milano

13 Neuron-Silicon Connection Antonio Pedotti

14 Neuroprosthesis 14 Antonio Pedotti

15 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 DBS is a clinical effective treatment for several neurological and neuropsychiatric disorders (mainly Parkinson disease) Stimulating electrodes are placed in deep brain structures LFPs recorded during stimulation LFP filter for stimulation artifact removal LFP are recorded directly from human subcortical structures and parameters extracted from the signals can be used for more personalized and optimized stimulation

16 Y [mm] Antonio Pedotti 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. Back swing Protesi 1 Protesi Z [mm] Impact Follow trough Set up Finish 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.

17 IMAGING- MSCT: sensors + computational modelling high speed and resolution, low dose Antonio Pedotti

18 Antonio Pedotti

19 Knee virtual simulator

20 Knee virtual simulator

21 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

22 Detezione lesioni tumorali Antonio Pedotti

23 Broncoscopia virtuale : chirurgia mininvasiva Antonio Pedotti

24 Click to add text Click to edit Master text styles Second level Third level Fourth level Fifth levelz Click to edit Master text styles Second level Third level Fourth level Fifth level PLACE IMAGE HERE Cardiac Pediatric MRI Visionary Techniques. Visible Results. 24 GE Healthcare Discovery MR750w

25 Fctn 2D FIESTA Cine Excellent non-contrast functional assessment ASSET compatible for high temporal resolution Flow Cardiac MR Morph Tissue LV and RV volume measurement in ReportCard 4.0 Free-breathing acquisition with multi- NEX Retrospective or prospective gating for patients with normal or arrhythmic heart rate Visualize flow jets in ASD or valve diseases Courtesy: Lucille Packard Children s Hospital, Stanford University

26 3D Heart 6 year old child 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 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 efficiency. Courtesy: Lucille Packard Children s Hospital, Stanfor

27 Prospettive sviluppi futuri Ultrasuoni

28 Prospettive sviluppi futuri Ultrasuoni La modalità Fusion Imaging Fusion US/TC - Tiroide Fusion US/RM - Rene

29 Nuove apparecchiature dedicate alla Medicina Generale Interfaccia utente Esame fisico: Ispezione Palpazione Percussione Auscultazione.a livello della superficie Ecoscopio integra l esame fisico: Visione fluidi peritoneali Visione dimensione organi Visione posizione & q.tà dei fluidi Visione del cuore con un occhio all interno del corpo Il complemento allo stetoscopio

30 Antonio Pedotti 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

31 Scientific-technological Breakthrough :Forced Oscillation Technique (FOT) Antonio Pedotti 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

32 Antonio Pedotti Expiratory Flow Limitation (EFL) Inspiration Inspiration Inspiration Expiration Expiration Expiration Volume (l) Z in = Rrs - j Rrs Caw Ca Rrs at 5Hz cmh2osl -1 Xrs at 5Hz cmh2osl -1 1 ( Caw + Ca)ω Xinsp DXrs Xexp Time (s) Z in = Rrs - EFL j Ca 1 ( Caw + Ca)ω EFL DXrs>2.81 1,2 1) Dellacà et al. Eur Resp J, 2004; Editorial Comments on; 2) Dellacà et al., Eur Resp J, 2007 Ca>>Caw

33 Antonio Pedotti

34 Antonio Pedotti Background Quali possibili ambiti applicativi per questa nuova tecnologia coperta da IP? Forced Oscillation Technique Ventilazione Meccanica Diagnostica Home Monitoring Ottimizzazione automatica del livello di PEEP durante la ventilazione meccanica 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 Philips- Respironics in Dicembre 2008 Licenziata in esclusiva a Viasys- CardinalHealth nel periodo (4 anni) Resmon- Politecnico di Milano

35 INTELLIGENT MACHINES : Adaptive ventilator for optimisation of alveolar recruitment Xrs (cmh 2 O*s/L) 80 Overdistension 60 Volume (ml) Safe window 0 Derecruitment Pressure (cmh 2 O) -50 Optimal MAP Overdistension Collaborations: - Uppsala Universitett, Sweden; - Neonatal ICU, Ospedale di Monza, IT - Università di Milano Bicocca, IT Antonio Pedotti Xrs 2 fi 2 fc Derecruitment Pressure (cmh 2 O)

36 Xrs (cmh 2 O*s/L) Volume (ml) 80 Overdistension Safe window 20 0 Derecruitment Pressure (cmh 2 O) Antonio Pedotti Pressure (cmh 2 O)

37 Xrs (cmh 2 O*s/L) Volume (ml) 80 Overdistension Safe window 20 0 Derecruitment Pressure (cmh 2 O) Antonio Pedotti Pressure (cmh 2 O)

38 Xrs (cmh 2 O*s/L) Volume (ml) 80 Overdistension Safe window 20 0 Derecruitment Pressure (cmh 2 O) Antonio Pedotti Pressure (cmh 2 O)

39 Xrs (cmh 2 O*s/L) Volume (ml) 80 Overdistension Safe window 20 0 Derecruitment Pressure (cmh 2 O) Antonio Pedotti Pressure (cmh 2 O)

40 Xrs (cmh 2 O*s/L) Volume (ml) 80 Overdistension Safe window 20 0 Derecruitment Pressure (cmh 2 O) Antonio Pedotti Pressure (cmh 2 O)

41 Xrs (cmh 2 O*s/L) Volume (ml) 80 Overdistension Safe window 20 0 Derecruitment Pressure (cmh 2 O) Antonio Pedotti Pressure (cmh 2 O)

42 Xrs (cmh 2 O*s/L) Volume (ml) 80 Overdistension Safe window 20 0 Derecruitment Pressure (cmh 2 O) Antonio Pedotti Pressure (cmh 2 O)

43 Xrs (cmh 2 O*s/L) Volume (ml) 80 Overdistension Safe window 20 0 Derecruitment Pressure (cmh 2 O) Antonio Pedotti Pressure (cmh 2 O)

44 Antonio Pedotti Intelligent Machines : Adapive Feedback Ventilator Rif Pressuere Control algorithm Xrs A LP filter P ao V P AIRWAY OPENING FLOW AND Acquisition PRESSURE board PERSONAL COMPUTER STIMULUS GENERATOR

45 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 Data server INTERNET Mobile network GSM GPRS UMTS Rm-in [cmh 2 O s L -1 ] 16 Patient 14 Control Xm-in [cmh 2 O s L -1 ] Day Landline or broadband connection Collaborations: St. Elizabeth Medical Center, Boston, USA Boston University, Boston, USA Antonio Pedotti Web access to data server

46 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

47 Antonio Pedotti ABOUT FUTURE «It is very difficult to make predictions, particularly when it is about future» Albert Einstein

48 Prospettive sviluppi futuri Ultrasuoni The next step?

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