Invent: Health

Imaging Technologies: Smaller, Cheaper, Better?
Speakers: Matthew Parker, Paul Cload & George Wylde
[Music Playing]
Matt: Hello, and welcome to Invent Health, a podcast from technology and product development company, TTP. I'm your host, Matt Parker.
Over the course of this season, we're going to be exploring the fascinating future of health technologies. Today, we ask, how will a new class of imaging systems transform the way patients are treated?
When you think about medical imaging, what do you imagine? Maybe ultrasound, if you've had a baby. Perhaps, the ghostly shadow of an X-ray, if you've broken a bone.
What about the giant white donut of an MRI or a CT machine? They're often a first point of call for physicians who need to get a detailed view of what's going on beneath the skin.
And each of the different types of imaging modality has different strengths, whether you care more about spatial resolution or the size of your target, soft tissue contrast or the speed of capture. But one thing that stayed fairly constant is the scale of these systems.
While an ultrasound system is rapidly portable, CT and nuclear imaging suites are enormous room scale systems. But what would it unlock if you're able to bring the size and portability of an ultrasound system to these other modalities?
If you're able to shrink them down to a size where you could move them to a patient's bedside or even put them in the back of an ambulance, what would being able to take accurate medical images immediately after a traumatic event be able to do for patients?
So, we're on record. This is it. How exciting. So, thank you for joining us today, George. I'm looking forward to our conversation.
George: Excited to be here.
Matt: So, this week I sat down with George Wylde, a colleague of mine at TTP to find out some more about the field. George is a technical consultant at TTP. With a PhD in biophysics, he combines a passion for medical imaging and sensing inside the body with the love of building things.
George and I started by breaking down some of the history of medical imaging and what some of the different modalities let you see from X-ray to MRI and more.
I wonder if we could start by … if you could maybe just tell me a little bit more about why we use imaging technologies in healthcare, maybe in a hospital setting for context. What are some of the different use cases?
George: Yes, of course. So, fundamentally, medical imaging enables you to do many things. Possibly most important is to see inside the body.
So, it's involved in the diagnosis, treatment, and monitoring of disease. It's also involved in screening for disease. So, if you have a mammogram, you'll know that you have an X-ray to scan for that, so diagnosis.
So, you are looking inside the body for either abnormalities in function, or you are looking for abnormalities in structure (sounds a strange way of saying it). But if you've broken your bone, you see on an X-ray that it's broken, but it's the imaging technology that has shown you that.
So, once you've got the diagnosis, you can also use medical imaging to help with the intervention. So, the intervention is a treatment. Can be your surgery, is probably the most common thing people think of.
But if you know where you're going and you know what you're trying to do, you can more accurately treat the disease. It can lead to better patient outcomes. And medical imaging can help guide that process.
Matt: So, there's kind of those two sides. There's a diagnosis side and an interventional side, I guess, would be the two broad classes there. And I wonder how long have each of these been in use? I'm imagining X-ray is one of the earliest.
George: Yes, you're correct. X-ray is the earliest technology. We've had it for well over a hundred years now. It's evolved up into the fully three-dimensional digital X-ray systems.
The images are reconstructed extremely rapidly, utilising modern electronics and an algorithm processing algorithms and all of the computing power we now have.
I'm not sure what came next — possibly nuclear medicine. So, instead of using X-rays to well shine radiation through the body and you’re relying on the absorption of those X-rays by dense tissue or dense structures, notably bones.
The nuclear medicine takes a slightly different approach. And it actually injects the elements that emit radiation, the sort of high energy photons switch pass very easily through the body.
It puts those into your body and they're normally bound to a molecule of some description that recognizes some things specific that you are interested in. So, it might be a chemical that's particularly taken up by a cancerous cell.
So, and then the cameras that already used externally to visualise where they're going. So, X-ray is a sort of structural thing and this nuclear medicine that came next allowed you to assess more functionally.
Matt: You’re sort of pinpointing the source there inside the body somewhere and then looking for it with the same kind of technology you would otherwise for an X-ray.
George: Yes. Exactly.
Matt: On a basic level. On a basic level.
George: Yeah. So, X-ray and nuclear medicine use high energy photons largely transparent your body. Ultrasound you mentioned is a different technique.
So, people will be probably familiar with sonar for detecting ships and things, or submarines under the water or mapping the seafloor. Ultrasounds is exactly the same technology that it's used for mapping the internal structures in your body, and it uses pressure waves.
Matt: Yeah. We've got sound, we've got high energy. What about something like MRI?
George: Yeah. So, MRI is an incredible technology. It does something slightly different. So, it looks at … I don’t know how to make the physicist inside me not squirm.
It uses magnetic fields to generate contrast. So, magnetic resonance imaging, all of your cells, well, even actually your atoms themselves have protons in them. And these protons you can see them, they're spinning.
And you use an external magnet, which has to be very uniform, very strong, much, much stronger than the earth's magnetic field to control how these magnets spin inside your body. And by some very clever bits and pieces involving changing magnetic fields rapidly.
And you can locate how these little magnets are spinning. And how they spin is related to what's going on around them, and what's going on around them is the contrast that you use to recreate your image.
So, it's a completely non-invasive technique. So, there's no ionising radiation. There's no damage delivered to the body, but you can create extremely detailed images.
And MRI, it's also probably most impressive thing about it is it's so unbelievably flexible. There's so many different ways you can generate images to target different things.
You can even see sort of distributions of chemicals inside the body. So, even in the brain, you can see the uptake of different chemicals and use those to guide both diagnosis and intervention as well.
[Music Playing]
Matt: Medical imaging is so much more than just X-rays for broken bones. The advent of technologies like MRI has allowed conditions to create a full picture of what's going on beneath the skin.
The structure of the body is key here, and MRI and CT in particular, given the high spatial resolution images they can achieve. But I was most interested in George's description of nuclear medicine technologies and the potential to not only see the structure of tissues and organs, but gain insight into their functionality.
Like CT, these are also room scale systems. I wanted to go deeper into these molecular imaging technologies to explore how bringing the system to the patient rather than bringing the patient to the system could be really game-changing.
So, I got in touch with someone who's part of a company who have created a device, which does just this.
Brilliant, Paul, well thank you for joining us today.
Paul: Yeah. Okay. Well, first of all, thanks for the opportunity to talk here today.
Matt: Dr. Paul Cload is the chief marketing officer of Seracam Imaging Systems. With over 30 years’ experience in the global pharmaceutical medical device and diagnostics industries, Paul brings a real knowledge of all areas of the bioscience space to his work with Seracam.
And what they are creating at the moment is really interesting, a breakthrough molecular imaging technology that helps physicians deliver personalised medicine to patients.
I started off with Paul by focusing on nuclear medicine in particular, asking him about how the traditional systems work and what benefits and challenges they bring to people working in the medical imaging space.
When we're looking at nuclear medicine, a technology that's been around for some time. Where did we start out with that? And I guess I wonder if you could take us on that journey a little bit about where we've got to.
Paul: Yeah, I mean, as with all other medical imaging technologies, there's been tremendous progress over the past few years. And again computer processing has been a major part of that.
And initially, nuclear medicine systems, they just had a single detector system. And that could produce 2D images of a relatively small field of view maybe looking at the head, the chest, the abdomen, for example.
Now, the modern systems, they tend to have multiple detectors capable of producing 3D images. And they can produce images of the whole body in the matter of a few minutes as well. So, really powerful technologies that we have available to us at the moment.
But these modern systems, yes, they're incredibly sophisticated and powerful, but it comes with increased size, weight, and cost. We're talking here, a systems weighing several hundred kilograms. They literally take up a room.
You need a dedicated room to house one of these systems. And in terms of cost, you're looking in some cases, well north of a £1,000,000. So, very sophisticated-
Matt: Substantial-
Paul: It's a substantial investment. And not just in terms of cost of the system itself, you also have to have a dedicated room. You have to have the space available to actually put this in. And of course, a lot of hospitals finding room is an issue these days.
Matt: Absolutely. And you can kind of understand that a kind of a room size system, does that limit the number of applications from this technology? Are there other places where you'd want to be using this kind of nuclear medicine imaging, which isn't compatible at the moment with I guess, a room sized device that you have to take the patient to?
Paul: Yeah, I mean, yeah, certainly. The majority of patients that benefit from molecular imaging can actually be referred to the nuclear medicine department where these systems are housed. So, maybe inconvenient, may take a bit of time to arrange the visit or whatever. But for the vast majority of patients, it's okay.
But there's obviously a number of patients who just can't get to the nuclear medicine department. And if it's a patient in the intensive care unit or undergoing surgery or whatever, then those patients obviously can't get to the nuclear medicine department.
[Music Playing]
So, under those circumstances, yes, molecular imaging still has very real benefits and patients could benefit from it. But they can't access it currently because there isn't a system that you can actually take to the patient.
Matt: The insight that a nuclear medicine can give us is truly unbelievable. And across all modalities, we're getting better resolution, speed, and detail. But there's still one constraint that's been hard to overcome: size.
The need to bring the patient to the system really limits the application in certain contexts, including for CT and MRI. So, I wanted to understand what miniaturisation might enable and what the barriers are to doing this at scale.
I went back to George as he's keeping a close eye on the start-ups that are leading the way here.
What I'm imagining there are these sort of, these big room scale systems, machines, installations. Is there any area for improvement that we might see start-ups or incumbents challenging some of the big four, five companies that make these systems? Where is sort of some of the other innovation happening in this space?
George: Yeah, so you're right, the MRI and CT systems are enormous. So, a number of start-ups are interested in trying to upend clinical workflow and improve patient safety. So, take as an example, the ICU.
So, if you're in critical care, moving you is generally not desirable. The MRI suite may be down the corridor, in the lift across some stairs. So, you have to be moved there from ICU and that's dangerous and it carries a risk.
So, there are a number of companies. Take Hyperfine, for example, is a start-up company that's developed going in the opposite direction to some of these bigger magnets, more expensive, better images, and has gone well. We'll make it smaller, we'll make it portable. We'll make it specific.
So, targeting neurology, and it's a portable system that can come to the bedside. So, in the ICU, you have less risk for the patient. You could also streamline your workflow. So, they're not the only company that that's doing that. There's examples in the CT space. So, SOMATOM are a company that's sort of shrunk a CT system down.
I don't know it's not quite a polo now, but of course, you have to fit your head in it. But if you have a stroke or you are potentially having a stroke, and the doctors obviously want to know — time is really critical of the essence.
So, if you can have a system that's goes to the patient, then you stand a better chance of getting the intervention you need in time. So, they have introduced mobile CT systems into ambulances.
Matt: Into ambulances. Okay, wow. So, that's a significant shrink there from something that fills a room to something fills an ambulance. What's the limitation there? What makes it difficult to shrink these systems down and to make them portable?
George: So, you are always making some trade off in the design of these systems when you do that. So, it can either be in the performance that can be either in sort of resolution. So, your ability to distinguish small objects apart, it can be in the amount of time it takes to acquire an image.
So, say Hyperfine, it's a very low-field MRI, it will therefore, suffer from relatively low sensitivity. So, it could take longer to acquire images. Or you can use some advanced reconstruction algorithms to try and help recover some of that image contrast and overcome some of the limitations of these machines.
But it is undeniable that they will be slightly more limited. The big systems can also do whole body imaging. So, when you shrink them down, you can pick a particular application and make it specific to that. And that can help sort of work around these limitations as well.
Matt: I wonder if maybe we could touch on some of the other sort of innovations in the space that we talk talked about there. So, I wonder if you could explain Serac’s technology and what that's doing and trying to achieve.
George: Yes, of course. So, Serac Imaging Systems have created a portable hybrid optical gamma camera. So, this is a system that's designed to image the distribution of radionuclides inside the body in a small field of view. But the advantage is that the system is portable.
[Music Playing]
Matt: But let's hold it there because our other guest, Paul, works for Serac Imaging Systems and is currently working on the implementation of the breakthrough technology, which George just mentioned.
I wanted him to explain some more about the nuts and bolts of the system Serac have just created, and how they got it to this place. What he told me about the technology that their Seracam is based on, and what this might enable was really fascinating.
Actually, I guess maybe it's a good place to sort of step back and maybe I guess, could you explain sort of Serac Imaging Systems technology more broadly? What is it that you've developed and how does it work?
Paul: Well, essentially, what we're developing is a lightweight, highly portable molecular imaging camera. And it's hybrid as well. So, as well as just getting a gamma image, you also get an optical image of what you're looking at as well.
So, it helps the physician able to sort of place the gamma image that they're seeing in an anatomical context. The technology, the detector system that we're using there was originally developed for a space observatory.
This is the sort of the Chandra and the Newton XN space observatories. Now, if you're going to put a detector onto a satellite, it's got to be small and lightweight.
Matt: Absolutely.
Paul: It's also got to be very durable because you're not going to have many opportunities to service that when it's 10,000 miles from Earth. So, what we've done with our system is we've taken that technology and we've repurposed it for medical imaging purposes.
So, it's basically been designed so that you can put the system onto a cart, which a single operator can move very easily through the corridors and the lifts in various hospitals, and take it to where the patient is.
So, those patients who cannot benefit from molecular imaging currently because they can't get to the nuclear medicine suite, where these large conventional cameras are held, can benefit from molecular imaging.
So, we're talking about patients in the ICU (the intensive care unit), the operating room, maybe patient bedside, physician's office, and the paediatric ward. If you can take the camera to a child rather than have to bring the child into a nuclear medicine department (which can be quite intimidating) then that could be very beneficial as well.
Matt: The portability aspect of it is bringing that, I guess, the potential of this molecular imaging technology to new places where it's not been used before, or whether it's just been challenging to use before.
Paul: Well, again, if you look at the ICU (the intensive care unit), there are patients who basically the technique that they need to determine how best to manage their condition requires them to have a nuclear medicine study, which requires them to go to the nuclear medicine department.
And you can imagine moving a patient from the ICU throughout the hospital all the way down to the nuclear medicine department, imaging them and then taking them all back as well. It's incredibly inconvenient can be stressful for all concerned.
So, if you can take the camera to the patient in the ICU, then obviously, that's a great benefit. So, that's one of the sort of applications that we see the camera being used for. But also, we can see it improving workflow in the nuclear medicine department itself.
There are many cases, there are many types of study where you don't really need a £1,000,000 very sophisticated system to get the image that you're looking for. A case in point is the thyroid study. You just need a simple five-minute scan, which we believe we can do quite easily with our camera.
And that's all you need. Why use a SPEC/CT camera costing a £1,000,000 which could be used for some other much more sophisticated procedure to do that? I suppose it's a bit like saying, “Well, I've got a Ferrari and I'll drive down to the shops in it to buy a pint of milk.”
Matt: Absolutely. Potentially, you could have a whole suite of these things doing some of these more straightforward applications and save the £1,000,000 machine for when it's required.
Paul: When it's really needed. The other thing as well is that demand for medical imaging is increasing all the time. As the population ages, older people require more imaging, basically. So, as the population ages, the demand for medical images is increasing.
So, how are you going to find space in your nuclear medicine department for another camera, which takes up a room and is a huge financial outlay as well. So, if you can use a portable, very small footprint camera to do those sort of easier study or simpler studies.
And then take the weight off or take the pressure off the SPEC/CT system, for example, then avoid having to make a great big financial outlay and find the space for a new camera.
Matt: I wonder is the system, is it being used in clinical practice anywhere yet?
Paul: No. I mean, it's still investigational at the moment. So, it hasn't been approved or cleared by the FDA in the U.S. or the UK or European regulatory authorities. So, it's just for investigational use at the moment.
So, we've spent the last, I think it's five years, it is, developing this system and bench testing it. But what I would say is we're not looking to replace the sophisticated systems. We see this more as complimentary. It's horses for courses.
And each product we think will find it's appropriate use.
[Music Playing]
Matt: Seracam is really exciting in terms of unlocking the insights of molecular imaging. But in a smaller portable machine, it ticks all the boxes. And what Paul said about using a simpler camera for simpler procedures is really true.
The potential for having a fleet of multiple machines, instead of only a single more advanced system might allow rapid personalised treatment onsite for patients, saving many lives or stopping future complications in the process.
But that's not the only innovation here: Seracam is an example of sensor fusion. Allowing both gamma and visual signals to be layered on top of each other, combining different modalities to enable greater insight.
So, with this kind of thinking in mind, what do our guests see the future of medical imaging looking like? Will it be one where miniaturisation is prized above all else, where new imaging systems are targeted at more specific use cases, but where the insights from these different modalities are combined to enable even greater insight? I went back to George to find out.
The other area that we sort of talked on is really an exciting development in the future of imaging here, was around fusion. And I wondered if you wanted to maybe outline sort of what is fusion in this context and how it applies to imaging.
George: So, image fusion is taking images that are created by two different technologies and merging them and overlaying them together in some ways that you can use the strengths of one imaging modality to overcome the limitations of the other.
So, for example, there are big systems which are combined imaging modalities together. PET-CT is probably the biggest one. So, the big donut, which does your X-ray reconstruction algorithm with the injected tracer that is looking for functional activity.
So, you can see both the function and the structure overlaid on top of them. It's a more sort of complete powerful diagnostic tool.
Matt: I guess for you, George, where do you see some of the most exciting developments happening in this space?
George: So, one is I don't think there's any way to avoid the impact big data and AI is having in medical imaging. It's significant. It offers enormous benefits both to the diagnosis. So, enabling radiologists to make more accurate diagnosis.
I mean, the radiology work for it currently, it's normally double reading. So, you have two radiologists who have to look at a scan and they have to agree. Otherwise, it goes to some review panel to look at.
So, there's a lot of time involved. You have to sit through and look at a lot of scans. If you have an algorithm or an artificial intelligence system that is capable of looking at your images for you and just saying “No, no these ones are completely fine,” so you can remove significant portions of the radiologist's workflow and enable them to focus on the images that are more likely to have something malignant and that need to be dealt with.
Matt: And we talked about AI, I guess, here in the context of interpreting the result of a scan. Is it also being used in sort of generating these scans and internally within the machine as it were?
George: Yeah. Yes, they are. So, there are AI systems that are approved on the market. So, CT for example, they are used as deep neural networks used for reconstructing CT images. And they can reconstruct the images from lower quality data.
And lower quality in this case usually means that you've used fewer X-rays to generate the images, which is a benefit for the patients, a lower dose, therefore, lower risk of developing DNA damage and cancer down the line. So, yes, they are useful there.
[Music Playing]
Matt: AI is something that keeps coming back, time and again, when we talk about health technologies. We've gone into it in every series of Invent. While not a panacea, the way in which it's helping clinicians interpret huge amounts of data is seeping into every area of the health world.
And imaging is one of the areas which has been leading the charge here and a huge amount of healthcare AI start-ups are in the imaging space. But back to the hardware itself, I wanted to finish off with some more on Seracam.
Because Paul told me that it's doing things which are not available in any other medical imaging device on the market at the moment. And what other fields could it be used in, given the portability of it? Could it be used outside the hospital as well? He seems to think so.
Paul: So, originally, we're focusing on nuclear medicine positions, but we do see significant opportunity for the camera as well in the surgical setting. Nuclear tracers are used frequently in oncology procedures, surgical oncology procedures.
And again, it’d be very good to have a camera that you can actually use in the operating room as the surgery is ongoing run rather than having to sort of image the patient outside, bring them back in, and then perhaps sort of image them again outside and bring them back in. So, to make it much easier for those procedures to take place.
Also, the camera, it's a hybrid camera, as I said, it has an optical capability as well. So, one of the exciting opportunities for the future is to modify that optical camera so it can detect fluorescence traces.
Because fluorescence traces are increasingly used again in surgical procedures. So, to have a hybrid gamma fluorescence camera could actually be really exciting.
Matt: I think it's a really exciting potential there because that's not something that's currently enabled by any of the existing technologies.
Paul: No, we don't know of any gamma fluorescence system that's available at this point in time or in development. So, yeah, that could be a very sort of valuable addition to the physician's armamentarium as it's called.
Matt: I guess sort of future, you are working towards there both in terms of the workflows that this might enable. But yeah, I think also the kind of the roadmap and the potential for this technology, I think is also very interesting to discuss.
Paul: Yeah. And again, we spoke about the sort of the clinical applications in nuclear medicine and also surgery, but molecular imaging is also used extensively in preclinical imaging, drug development studies, for example. And again, we see an opportunity for the camera there.
The other thing that we're looking at, which is a bit further away, shall I say, because it's not an area that we know very much about, but it's decommissioning of nuclear power plants.
Matt: Oh, that's a bit of a segue, yeah.
Paul: It's a bit of a-
Matt: Super interesting.
Paul: And again, they're basically looking to see where there's radio activity. Now, a lot of the isotopes that are used or that are relevant in nuclear power plants and reactors, they actually emit gamma rays. So, our camera can image those.
Matt: I guess that brings on quite nicely. I guess, what aspects are you most excited about going forward in this space?
Paul: For us at Seracam Imaging Systems, I suppose it might sound a bit cliché, but what really excites us is the potential for Seracam to really improve patients’ lives and help their families as well.
But as I said, we've spent the past five years developing the system and bench testing. We're now just about the process to get out and try it with real patients in a test situation as it's not approved for clinical use.
But it'd be great to get some images where … and these are patients who have been scheduled to actually have a conventional scan. And then, we'll just get their permission to image them with our camera as well, so we'll able to do a direct comparison. So, it's really exciting to get those first clinical images.
Matt: At that point, these sort of mind races at the different myriad opportunities that might unlock once these are released into the wild almost.
Paul: Yeah, I think we're just getting started, so it's these very exciting times.
Matt: Well, thank you so much for joining us today and sharing the story with us.
Paul: Thanks. I think it was a very good discussion. Very much enjoyed it, and yeah, I hope the listeners enjoy it too.
[Music Playing]
Matt: That's all for today, and thanks so much for listening to this week's episode of Invent Health from TTP. And a huge thank you to both Paul and George for sharing their knowledge of the past, present, and future of medical imaging.
We'll be back next time with an episode looking at how developers and clinicians are designing for trust in medical systems with a special focus on digital health.
If you enjoyed this episode and you want to let us know, please do get in touch on LinkedIn, Twitter, or Instagram. You can find us at TTP. And don't forget to subscribe and review Invent Health on your favourite podcast app as it really helps others find our show. We'll see you next time.