Imaging devices – today’s innovations and tomorrow’s potential

Interview with Bert van Meurs, business leader of Image-Guided Therapy at Philips, by Jonathan Patience (Senior Editor)

In August 2017, more than 31,700 healthcare professionals from 153 counties came together in Barcelona for European Society of Cardiology congress to share and discuss the best innovations and most anticipated cardiovascular sciences of the year. Among them was Bert van Meurs who is the business leader of Image-Guided Therapy at Philips and an expert in cardiac technologies with a specific focus on image-guided therapies. Speaking to Jonathan Patience, Senior Editor at Taylor & Francis, Informa plc, he talks us through the latest innovations at Philips and the future for imaging devices.

Jonathan: First of all, would you be able to summarise why image-guided therapy is important?

Bert: Image-guided therapy is not new; however, there has been a lot of development. Basically, image-guided therapy is the change from open surgery to minimally invasive procedures where, instead of cutting open a patient’s body, you use instruments and devices such as catheters to go inside the body, with minimal invasion.

However, to see where you are going, you need imaging to guide these devices to the right location to deliver the correct therapy. Today, the gold standard in this is angiography, where advanced instruments are being combined with x-ray imaging.

This is important for both — patients and healthcare providers. For patients, it means that there is less trauma and pain – letting them leave the hospital nearly on the same day. It also means proven outcome improvements for the patients - and at lower cost -because having a patient in the hospital after surgery for a longer period involves a significant cost.

Another important use is in structural heart disease where you can actually replace a complete aortic heart valve in people with valvular disease, although these patients are often not operable. Also, where there’s the smaller vessels in the brain, you can close an aneurysm, and heart rhythm disorder which can be treated by ablation. We can even treat a tumour with interventional oncology using a catheter tube to go to that specific tumour and deliver ablation, or embolisation, or a kind of small chemotherapy at the site itself.

Jonathan: So it affects a variety of fields then – in what fields would you say it has advanced the most?

Bert: Well, what it has most advanced is the field of percutaneous coronary intervention – the treatment of a heart infarction for patients with coronary heart disease where you simply open these coronaries again.

Image guided therapies are also increasingly being used for vascular treatments. Peripheral artery disease is a significant disease and perhaps not as well-known amongst the general public as it has a more cumulated effect, rather than a sudden one. By using image-guided therapy, we can also help prevent these cases as well. There are millions of patients in the world who are suffering from peripheral artery disease and a significant amount of people who may need to get an amputation – very often even before an angio image is made.

Another area which is advancing is neurology – for patients who suffer from brain aneurysms and strokes, the latter of which can be treated more and more with minimally invasive and image-guided therapy. So, these are, I think, the most advanced areas today: coronary, cardiology, vascular, peripheral vascular, and neurology.

Jonathan: What are the main challenges in those fields and how can image-guided therapy address those?

Bert: I think that if you look at the challenges in healthcare today, it is about driving efficiency and reducing cost whilst still maintaining high quality care for patients across the board. Image-guided therapy has delivered on these challenges and is improving workflow.

This year, we at Philips have introduced Azurion which is a whole new platform for a next generation of our cath lab systems. The main improvement of that system is to drive forward efficiency and improve workflow to result in more effective healthcare delivery at a lower cost. A verified study recently demonstrated clinicians’ use of Azurion resulted in significant time savings for the hospital, including a 17% reduction of the average procedure time [1]. Another challenge of healthcare today is that patients often need to be treated in hospital settings – which are expensive. We are now beginning to see a trend towards lower-cost settings such as office-based labs, as can be seen in the U.S. As systems become more advanced, some techniques become more routine and therefore may not always have the requirement of a hospital room and instead can be carried out more quickly, in less expensive ways.

Jonathan: So, in addition to what you’ve already mentioned, what else would you say are Philips’ main recent innovations?

Bert: Along with the Azurion platform mentioned previously, another very important innovation is to be able to carry out these procedures with reduced radiation from x-rays. Philips have introduced what we call Clarity IQ, which is a new technique that can reduce the radiation significantly.

Then, we have developed our so-called Echo-Navigator that combines 3D ultrasound, and live fluoroscopy in real time. This allows physicians to position devices and instruments at the same time to replace a heart valve by using a combination of ultrasound and x-ray, which is much safer for the patient. By combining more and more different imaging modalities, we are able to develop more software that shows x-rays as 3D reconstructed images, which you can manipulate in real time to have a better overview.

In addition, we can also use Intravascular Ultrasound, an ultrasound transducer that is highly miniaturised and can be integrated on tip of a catheter, allowing you to actually look inside blood vessels to identify risks and treatments. Alongside that, using a new intravascular physiology measurement technique called iFR (Instanteous Wave-Free Ratio), you can measure whether you should place a stent or not. .

The latest addition to our portfolio are devices that are meant for the treatment itself such as drug-coated balloons like Stellarex, with which you can open a vessel and deploy a specific drug to treat the actual disease in the vessel wall.

Jonathan: How would you say these innovations have changed clinical practice recently and will we see more changes resulting from them in the future?

Bert: I would say clinical practice has already changed because of these innovations. For instance, we are seeing a real growth in the number of procedures involving the replacement of aortic valves with the assistance of 3D ultrasound. Also, with interventional oncology, we are seeing physicians treating specific tumours in new and exciting ways.

Looking at the future, there are new areas and new procedures where image guidance is being used in interesting ways. As an example, we’ve just introduced a new technique for spine surgery where you can more accurately place screws for spine fusion.

Jonathan: Are there other innovations that you see coming about in the near future?

Bert: Another very interesting area is augmented reality, where specific information can be overlaid over the patient, viewable to the surgeon who then has more guidance and data at a glance, in real time.

Philips also has a lot of in-house technology: miniaturisation and different types of navigation technologies that can really make catheters and associated devices smarter and more intelligent – steering towards lesions faster without the need for x-rays.

Jonathan: What would you say are the remaining hurdles before this technology can be implemented more widely in clinical practice?

Bert: Well, I wouldn’t really call them hurdles but in the medical field, we are of course a regulated business, so all new tech needs to be approved for use in the different areas (e.g. US Food and Drug Administration approval in North America). Gathering clinical data is a big part of proving efficacy, so we are always running trials to put together proof points.

The other thing, of course, is the adoption of clinicians. To adopt new techniques, education and training are important to make sure that the new tech is actually beneficial in day-to-day operations.

Jonathan: Apart from the fields you have mentioned already, how do you see the usage of image-guided therapy evolving in other fields over the next five years?

Bert: First of all, you can look at where minimally invasive therapy is being done. Today, it’s in the hospital, but there will be more of a shift towards lower-cost care settings, such as clinics and office-based labs. The other areas, which I already mentioned, will centre more around new clinical application areas like surgical spine surgery and oncology.

A very interesting area is hypertension. There are many patients with hypertension who are not responding to drugs; however, here a new interventional, image-guided therapy technique known as renal denervation, could potentially offer a solution. This is where you ablate the nerve in the renal artery, and there are ongoing clinical studies on how this can help to reduce hypertension. Furthermore, we will likely see a lot of new imaging with ultrasound and smarter devices, which will help reduce x-ray radiation further by smarter guidance and smarter navigation, benefiting hospital staff and patients.

Jonathan: Finally, why is Philips moving into these devices?

Bert: You won’t see any other company who is looking at a combination of imaging and therapeutic catheters, and we believe that we are able to develop solutions greater than the sum of their parts. So, that’s what we’re working on and that’s why we’ve invested significantly over the last few years in companies that really have a leadership position in specialty devices which can add to our overall solution.

And at the end of the day, our philosophy is to not just to look at the system itself, but to look at how we can help our customers to treat patients better, and how can we develop more effective procedures. This is what we plan to achieve with improving imaging and creating smarter devices across the board.

Declaration of interest

B van Meurs is an employee of Philips. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This article was not funded.