The following is a brief summary of a joint Royal Society of Medicine/Institute of Engineering & Technology event held at the Academy of Medical Sciences on 6th May. The event was organised, extremely professionally, by the IET events team. The last ticket was sold half an hour before the start, so it was a genuine sell-out.
The speakers for the event were jointly chosen by this editor and by Prof Bill Nailon, who leads the Radiotherapy Physics, Image Analysis and Cancer Informatics Group at the Department of Oncology Physics, Edinburgh and is also a practising radiological consultant. As more of those invited by Prof Nailon were available than those invited by this editor, the day naturally ended up with a strong focus on advances in the many aspects of radiology as applied to imaging & treating cancer, as a surrogate for the wider examination of how medicine is changing.
The event began with a talk by Prof Ian Kunkler, Consultant Clinical Oncologist & Professor in Clinical Oncology at the Edinburgh Cancer research Centre. Prof Kunkler began by evidencing his statement that radiotherapy delivers a 50% reduction in breast cancer reappearance, compared with surgery alone. He stressed the importance of careful targeting of tumours with radiotherapy – not an easy task, especially if the patient is unavoidably moving (eg breathing) – Cyberknife enables much more precise targeting of tumours as it compensates for such movement. Apparently studies have shown that 55% of cancer patients will require radiotherapy at some point in their illness.
This was followed by Prof Joachim Gross, Chair of Systems Neuroscience, Acting Director of the Centre for Cognitive Neuroimaging & Wellcome Trust Senior Investigator, University of Glasgow, talking about magnetoencephalopathy (MEG), which enables excellent spatial & temporal resolution of the brain. However it currently uses superconducting magnets that in turn require liquid helium, so is very expensive to run. He then showed an atomic magnetometer which apparently is developing fast and will be a much cheaper alternative to MEG – he expects people will be able to wear sensors embedded in a cap soon. He then went on to show truly excellent graphics on decoding brain signals with incredible precision; he explained that the 2025 challenge is understanding how the different brain areas interact. Finally he described neurostimulation, using an alternating magnetic field with the same frequency as brain waves to change behaviour; whence the emergence of neuromodulation as a new therapy. Both exciting, and just a little scary.
Dr David Clifton, Lecturer, Dept of Engineering Science & Computational Informatics Group, University of Oxford, followed with a talk on real-time patient monitoring. He began by explaining the challenges that clinicians face with this wall of patient data coming towards them: only “big data in healthcare” enables all the data generated by patients to be analysed to identify the early warning signals that are so important to minimise death and maximise recovery. He explained one unfortunate consequence of our litigious times: too precise prediction risks legal challenge, so most manufacturers only show vital signs, leaving it to the monitoring person to draw conclusions unaided. However he believes there is middle way to use the predictive ability of technology. He explained that patients dislike sensors so a company recently spun out of the university is measuring vital signs using video signal processing – they analyse 1TB of data every four hours, to record vital signs such as SpO2, respiration and pulse rate. Finally he described how machine learning plus a DNA sequencer enables identification of antibiotic-resistant bacteria, to improve treatment of diseases with extensive antibiotic resistance, such a tuberculosis.
He was followed by Bill Sandham, Director of Scotsig, Visiting Professor of Starthclyde & Javeriana University, Colombia and Director of Diabetes Technology Research, HCI Viocare whose grasp of mathematical signal processing was awesome & well beyond the comprehension of this editor. For example he explained how, despite the benefits of Woody’s cross-correlation averaging on evoked potential analysis, single sweeps were still preferred. Easier to comprehend was how huge improvements had been achieved in ECG signal processing since the first ECG in 1887. Another current activity was developing a system to predict future blood glucose using a neural network, to improve operation of artificial pancreases (which currently lag normal bodily responses because of this inability to predict future requirements). He ended with an extremely important, and easily understood, statement that 1% of the NHS’s budget is currently spent on foot & leg amputations due to diabetic neuropathy – he maintains that this is almost completely avoidable.
After the break, Prof Luc Bidaut, Chair of Translational Imaging and Director of Imaging for the Centre of Oncology and Molecular Medicine (COMM), University of Dundee, showed a series of astonishing pictures from merging imaging from different techniques of the same body part, including the ability to rotate these in three dimensions – so astonishing were they that this editor took few notes. One of the great benefits of such imaging is that it can help clinicians determine whether a chosen cancer treatment is going to be successful much earlier than currently, so changes can be made if it is not working, and before the cancer has progressed much further.
Ken Sutherland, President, Toshiba Medical Visualisation Systems, then explained how his company is using computing to correlate patient images with an idealised model of what that body part should look like, to present a most helpful image to clinicians, eg with different parts of the brain colour coded, or otherwise labeled. (Later in response to an audience question, he explained that action is also underway to work out how to annotate scans so patients can better understand images, too.)
He went on to extol the benefits of Data Driven Healthcare – how to get for example sociological, activity, diet etc. information combined with health data & analysed as a single data set. A challenge that is getting ever harder with data privacy regulation tightening.
After lunch, Prof Rachel McKendry, Professor of Biomedical Nanotechnology at University College, London, gave a superb talk on using technology to anticipate epidemics. She explained how using smartphones to improve public health could turn back the clock to diagnose an illness at the start of the patient feeling ill. However she cautioned that “symptoms are not diagnosis” so there is a need to take care to confirm a disease – she extolled the benefits of Flusurvey as a good example, including the recently introduced incl self-testing group. One way of enabling home diagnosis was a bio-barcode of different biomarkers that enable diseases to be diagnosed by using a smartphone camera to capture the image of the resulting bars, akin to the sticks used for urine analysis – such a clever idea. However she cautioned that as with so much new technology, home diagnosis only really works if the information is accepted & responded to by the clinician…in this case by returning an electronic prescription to the patient’s phone.
Prof Alan Murray, Head of the Institute of Bioengineering, University of Edinburgh, talked about implanting devices for improving cancer treatment – the Impact project. He explained how by implanting a three dimensional array of sensors around a tumours to measure pH, O2 enables the optimising of radiotherapy. He went on to explain how a minute ISFET (ion sensitive field effect transistor) with a pH or O2 sensitive layer on gate can detect these. (NB many speakers talked about hypoxia as a key concern in radiology, because the blood supply in tumours is chaotic so easily disrupted, unpredictably, by radiation damage. When that happens, and the tumour is deprived of oxygen, it is both hardened against radiation, and becomes more prone to metastasising. pH likewise influences the tumour’s susceptibility to radiation damage, so both are important to measure.) He then showed a brilliant set of animations to explain how biochemical sensors work at measuring proteins. One serious issue is that as sensors get smaller, so does the signal, however the noise doesn’t, so ever smarter technology is needed to “denoise” the signal. Finally he showed us, in action, technology that he has developed that can deliver individual drug doses buried in wells in a silicon chip covered by gold foil. Astonishing.
Dr Luca Cozzi Clinical Research Scientist, Humanitas Research Hospital & Scientific Advisor, Varian Medical Systems talked about advanced cancer treatment using knowledge-based software. He described the importance of knowledge-based planning of radiotherapy sessions as patient variability affects dosage received. He explained that automation of radiotherapy dosage planning improves both efficiency & effectiveness, enables large throughput – the first results of using model for prostate cancer patients has resulted in planning time being reduced and, for cervical cancer, a much improved quality of radiotherapy.
After the break, Prof Gillies McKenna, Head of Department of Oncology & Director, CRUK/MRC Oxford Institute for Radiation Oncology spoke about personalised healthcare & precision treatment. He explained that by personalised cancer treatment we tend to mean molecular targeting, however experience to date is poor. He further warned – with some startling pictures to make his point – that tumours contain many different mutations so treating the dominant mutation tends to give only temporary remission. His take is that the interventions that do “cure” cancer can be split 49% surgery, 40% radiotherapy, 11% chemotherapy. To improve the effectiveness of a new molecular approach he suggested it is better to focus on early onset, before the cancer has mutated, & to combine it with other interventions. Having researched a wide range of drugs, he chose Atovaquone to reduce hypoxia in tumours – initial trials were very promising, so he has now begun a clinical trial. Finally he described the Oxford proton beam therapy unit, which allows greater precision, avoiding harm to some organs that radiotherapy could damage (because the protons stop, whereas many X-rays continue through the body). Note however that other speakers present privately noted that proton beams do have to be precisely targeted an are intolerant of even the slightest movement.
The final speaker of the day was Dr Jenny Barnett, Director of Healthcare Innovation, Cambridge Cognition, and Visiting Research Fellow, University of Cambridge Dept of Psychiatry, on cognitive assessment and early detection of dementia. Beginning with a picture of the development of sphygmomanometers from the earliest, she stated that Cambridge cognition’s mission is to produce a blood pressure monitor for the mind, using gamification. She explained the need to correct for age & education to determine whether cognition is normal; measuring impairment & change greatly improves the accuracy of dementia diagnosis. In response to a question from the audience, she explained that it was easy to screen patients if there are concerned about their memory, providing reassurance for most, and enabling earlier treatment for those unfortunately diagnosed with dementia.
The overall impression given is of a huge range of technologies all contributing to amazing advances in medicine. In spite of the odd check, clearly medicine in ten years’ time will be very different from today – the role of the doctor in 2025 will perhaps, as Prof Rachel McKendry said, very much depend on whether the information provided by the technologies is accepted & responded to appropriately by the vast majority of clinicians. If not, the likes of Babylon, Dr Mortons & the 3G Doctor are sitting in the wings with an alternative technological approach that could be very disruptive.
Such was the feedback during and after the day that it is clear that there is a demand for repeating this event next year – the big question is whether to keep the date (and so reduce the forecast time to nine years), or keep the ten year forecast time (and so look at the role of the doctors in 2026)!
The whole event was videoed by a very polished IET team so doubtless in due course all – or most – of the presentations will be available somewhere on the IET website – watch this space.