VPH in future healthcare where will we be in 10 years from now? World of Health IT Barcelona, March 15-18th 2010 Alejandro F. Frangi, PhD Center for Computational Imaging & Simulation Technologies in Biomedicine Universitat Pompeu Fabra, Barcelona, Spain Networking Center on Biomedical Research – Bioengineering, Biomaterials and Nanomedicine Institució Catalana de Recerca i Estudis Avançats [email protected]www.cilab.upf.edu www.vph-noe.eu www.aneurist.org
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VPH in Future Healthcare. Where Will We Be in 10 Years from Now?
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VPH in future healthcarewhere will we be in 10 years from now?
World of Health IT
Barcelona, March 15-18th 2010
Alejandro F. Frangi, PhDCenter for Computational Imaging & Simulation Technologies in Biomedicine
Universitat Pompeu Fabra, Barcelona, Spain
Networking Center on Biomedical Research – Bioengineering, Biomaterials and Nanomedicine
We are seeing already the future in some of the current R&D projects
Still substantial acceptance, penetration, consolidation to be achieved
The challenge: demonstrating the anticipated clinical value
Some glimpses follow based on @neurIST…
www.aneurist.org 15
Cerebral aneurysm management
> The @neurIST “template project” Unruptured intracranial aneurysms are increasingly diagnosed due to modern
imaging techniques It is more and more important to develop holistic and sound approaches to patient
management.
Management of unruptured aneurysms is controversial decision making is currently based mainly on aneurysm size and location mainly
(ISUIA).
Wiebers D.O. Unruptured intracranial aneurysms: natural history and clinical management. Update on the international study of unruptured intracranial aneurysms. Neuroimaging Clin N Am. 2006 Aug;16(3):383-90
There is evidence that genetic predisposition may be involved in the natural history of aneurysms.
Krischek B, Inoue I. The genetics of intracranial aneurysms. J Hum Genet. 2006;51(7):587-94.
Currently endovascular treatment is favored over surgical treatment for many aneurysms (ISAT) both treatments are risky, costly and do not always prevent recurrence.
van Rooij WJ, Sluzewski M. Procedural morbidity and mortality of elective coil treatment of unruptured intracranial aneurysms. AJNR Am J Neuroradiol. 2006 Sep;27(8):1678-80
Molyneux A. Ruptured intracranial aneurysms - clinical aspects of subarachnoid hemorrhage management and the International Subarachnoid Aneurysm Trial. Neuroimaging Clin N Am. 2006 Aug;16(3):391-6
There is a need to support a new generation of endovascular devices treating the cause rather than symptoms of the disease
Two clinical questions
At-risk individuals/patient selection?
Optimal treatment planning?
VPH as a new perspective for More principled disease understanding and phenotyping,
Development of novel diagnostic and prognostic biomarkers, and
Computational tools for treatment planning and guidance
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Cerebral aneurysm management
> Natural history of complex diseases
Etiology
Unruptured
[99% silent]
Growth
Ruptured
Mortality
Morbidity
Normal
33%
33%
33%
Treat?
0.2-1.0%/yrPrevalence
1-5%
F>M
Treat!
?
Degenerative
Initiation
vasospasm clotting
ISAT (Oxford)
Coil vs clip
ISUIA (Mayo)
size/locationPrevention
Diagnosis
Treatment
Prevention,
follow-up
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PACS eRadiology Archives
Bio Bank
PACS
PACS
PACS
PACS
PACS
PACS
PACS
ISAT
ERGO
IPCI
NHRBonn
@neuQuest
@neurIST BioIS
Descriptive Data
Representative Data
Conservation of samples
I.H. Rajasekaran, L. Iacono, P. Summers, S. Benkner, G. Engelbrecht, T. Arbona, A. Chiarini, C.M. Friedrich, B. Moore, P Bijlenga, J.
Iavindrasana, R.D. Hose, A.F. Frangi (2008), @neurIST: Towards a System Architecture for Advanced Disease Management
through Integration of Heterogeneous Data, Computing, and Complex Processing Services, IEEE International Symposium on
Computer-Based Medical Systems, Finland, pp. 361-66.
Cerebral aneurysm management> Gathering evidence across Europe
Cebral JR, Lohner R. Efficient simulation of blood flow past complex endovascular devices using an adaptive embedding technique. IEEE
Trans Med Imaging. 2005 Apr;24(4):468-76. 22
Clot formation: A subtle interplay of genetics,
haemodynamics and arterial wall mechanics
Coil-induced clot formation is the basis of endovascular treatment for cerebral aneurysms; on the other hand spontaneous formation in untreated aneurysms is potentially loose and embolic.
Computational modelling allows for the evaluation of haemodynamic, rheological and genetic factors in thrombus formation. Models accounting for activation, biochemistry and thrombus-blood coupling will help us track the various stages of the thrombogenic process, and evaluate their significance in disease and treatment.
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A. S. Bedekar, K. Pant, Y. Ventikos, S. Sundaram, A
computational model combining vascular biology
and haemodynamics for thrombosis prediction in
anatomically accurate cerebral aneurysms, Food
Bioprod Proc 83 (C2), 118-126, 2005
Evolution of the distribution of thrombin
concentration
Cerebral aneurysm management
> Individualized risk management
Courtesy InferMed & COSSAC University of Oxford (Prof. J Fox, Y. Chronakis) 24
DISCUSSION & CONCLUSIONS
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EHRs, VPH and the Virtual Patient Metaphor
In practice is very unlikely to have all needed measurements before simulations can take place
VPM: A virtual patient is a logical entity that can be queried for any and all information about a human being
E.g. on-the-fly access to population average parameters where personalized data is not available
E
A
Y
B
Z
C D
@neurIST Database
Virtual Patient
Literature
Mr Jones
X
Average & deviations
input conditions
(Flow waveforms,
pressure,
haematocrit, etc… )
Derived data
Input requirements
+
Age, sex, clinical
history,
genotype, etc…
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VPH applications & ubiquitous sensing
Personalization needs to consider in which homeostatic conditions the individuals is while being sensed
Consider environment and allostasis
“Is this patient at risk of IA rupture?” considering his/her
Exercise-rest conditions,
Stress levels,
Daily biorhythms,
Seasonal changes, etc.
Even more: “which will be his/her typical conditions under which this patient will be at risk”
Ubiquitous physiological monitoring technologies will ultimate have to connect to VPH technologies for true personalization and be integrated therein
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Conclusions EHR, PHS, VPH: tackle complementary issues to realize patient-centric/personalized care cycles
VPH will stimulate further developments of EHR and PHS and provided added value services for healthcare and medical product development
Low-hanging fruits of VPH-PHS-EHR are available which act as levers for most sophisticated adoption