Five innovations that are shaping the future of image-guided therapy

When I joined Philips almost 35 years ago, open heart surgery was the norm for treating conditions such as coronary artery disease. A patient would spend more than a week in the hospital. Today, a patient treated for coronary artery disease is often able to walk out of the hospital the same day – thanks to the development of minimally invasive procedures. It goes to show how image-guided therapy has revolutionized surgical procedures over the past few decades, and as Chief Business Leader for Image Guided Therapy at Philips, I couldn’t think of a more rewarding field to be in. 

But as I meet with clinicians and healthcare leaders around the world, listening to their needs, dreams and concerns for the future, it also becomes clear that what got us here won’t get us there. Together, we are really just at the beginning of a much longer innovation journey. As hospitals are pressed to do more with less, new solutions are needed to deliver improved care to more patients, while reducing costs, easing the burden on overstretched staff, and at the same time improving patient experience. In other words, what we call the Quadruple Aim. 

Looking at the future of image-guided therapy, I see particular promise in five exciting areas of innovation that can help deliver on this Quadruple Aim.

With AI, we now have the tools to start automating this process. Suppose we use AI to automatically track each step of a procedure, log relevant events and actions, and then auto-populate reports with images and measurements acquired during the procedure. A clinician would only have to review, complete, and sign off the pre-populated report at the end of procedure. 

This could make a big difference to both the clinician and the patient: every minute saved on reporting is a minute gained to interact with the patient.

I foresee that AI will also take on a growing role in providing real-time clinician decision support in the interventional suite. With minimally invasive procedures, every millimeter matters – especially in the most critical areas of the body such as the heart. Computer-assisted interpretation of images could go a long a way in further improving accuracy, offering a helping hand to the clinician. Already today, there are advanced methods to automatically recognize anatomical structures of the heart, based on ultrasound images.

In the long run, AI could also help to stratify patients to offer them the therapy with the biggest chance of success. For example, based on large historical data sets, AI may able to calculate the risk of bleeding or other complications during a procedure, depending on patient characteristics. Such a personalized, data-driven approach could help to improve outcomes, reduce complications, and drive down costs.

Earlier this year, we announced a collaboration with Microsoft to pioneer the use of AR in image-guided therapy, combining Philips Azurion with the Microsoft’s HoloLens 2 holographic computing platform. This joint innovation allows the clinician to keep his or her eyes on the patient, while superimposing live data and 3D medical imagery needed to guide precision therapy. Clinicians will be able to fetch data and perform actions with eye tracking, voice control, and hand gestures – creating a personalized ‘cockpit’ that allows them to focus on the patient.

Although still work in progress, it’s easy to see how tools like these could help clinicians navigate through anatomical structures more accurately. This could have a real impact on quality and efficiency of care, as well as staff experience. 

Training, education, and remote assistance are other potential applications of AR. What if you were able to follow a procedure in real time through the eyes of a colleague, and offer specialist advice where needed? It sounds futuristic, but with AR this could eventually turn into reality.

One exciting development in 3D ultrasound, with great promise for the future of image-guided therapy, is that we now have the ability to create live photorealistic renderings of anatomical structures using a technology called TrueVue. The images below show the amazing level of detail in prenatal ultrasound images of an unborn child. It’s like peeking inside the body with a high-resolution camera.

With our latest imaging systems, we have started bringing this technology into the interventional suite for cardiac procedures – offering interventional cardiologists sharp and detailed 3D ultrasound images that help them navigate through the heart and get a better view of heart structures such as the mitral valves (shown below). 

In the future, I envision that clinicians may increasingly be able to rely on photorealistic 3D ultrasound imaging applications for a wider range of procedures. Photorealistic rendering could also be applied to other imaging modalities, to further enhance procedural navigation.

For example, as I detailed in my previous article, in treatment of peripheral artery disease we can now take pre-operative CT and MR scans and overlay them on an X-ray image to create a 3D roadmap that guides the position of a catheter in real time. This reduces the need for additional X-ray imaging, limiting the burden on staff and patient.

Looking further ahead, I have high expectations of new, groundbreaking technology that could help clinicians visualize catheters and other intra-body devices in the context of the patient’s anatomy, from any possible angle, in real-time 3D – without having to step on the fluoroscopy pedal. Currently under research, this technology – called Fiber Optic RealShape (FORS) –  uses pulses of light that run through hair-thin optical fibers. By analyzing how the light is reflected back along the fiber, we can reconstruct and visualize the full shape of devices. Eventually, this could reduce the dependency on X-ray fluoroscopy while allowing clinicians to see more during their procedures.

For example, earlier this year we launched IntraSight, which integrates intravascular ultrasound (IVUS) and FFR or iFR physiological flow measurements. Because different actions can be performed via the same table-side touchscreen, with various information sources brought together in one overview, clinicians no longer need to pull this information from different places or look in different directions – saving them time and effort.

The ultimate vision is to create one seamless interventional suite; a place where all systems are connected and where the right information – compiled from different sources – comes to clinicians where and when they need it. 

But integration doesn’t end in the interventional suite. What if we could make it easier to reuse diagnostic imaging results for procedure planning, creating a seamless workflow from diagnosis and planning to intervention? What if, once the procedure is completed, we could streamline the export of results from the interventional suite to the EHR, PACS, and other hospital archiving systems, to ensure that the patient is followed up in the best possible way? 

Pursuing further integration across the entire patient journey has the potential to save time, reduce cost, and support seamless information exchange across settings.