la médecine de precision soutenue par l’iajficv.com/usrfile/presentation/2019/sym01-p01.pdf ·...
TRANSCRIPT
Abdelaziz LAOUAR, PhDMedical Innovation Manager, Western Europe
GE Healthcare
La Médecine de Precision soutenue par l’IA
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Precision Medicine
Conventional TherapyConventional Therapy
Patient A Patient B
Histology:Malignant Tumor
Molecular Analysis:HER2-positive
Molecular Analysis:HER2-negative
HerceptinHerceptin
Rezi
div
-fre
ies
Überl
eben Cx.. +
Herceptin
only Cx.
Jahre
Molecular Analysis for Decision Making in Breast Cancer
Histology:Malignant Tumor
GEHC Europe 2019 Live Broadcast l 28 January 2019 l Confidential. Not to be copied, distributed or reproduced without prior approval.
PATIENTS
RADIOLOGISTS
CLINICIANS
C-SUITES
GOVERNMENTS/PAYERS
MED TECH SUPPLIERS
Value based medicine driven by clinical outcomes with patient incenter…
Changing roles of healthcare stakeholders
DATA, MOBILITY, COST SENSITIVITY, TRANSPARENCY
TODAY/TOMORROW
Precision Health enabled by AI
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Precision Medicine
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Precision Medicine
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Precision Medicine
TO
FROM
PRECISION MONITORINGPRECISION DIAGNOSTICS
In-Vivo + In-Vitro
Protocol driven
Highly personalized
Precisely targeted clinical trials
Complex processes simplified. Precision interventions. Additive
Pro-active approach to wellness beyond the hospital
Costly and risky R&D
Complex and unguided
Patients only monitored when sick
Decision Making Therapy Innovation
Each patient... digitally connected
Therapy Delivery Monitoring
Integrated, longitudinal, fueled by AI
Too much data, in toomany different places
PRECISION THERAPEUTICS
Precision Health GE Healthcare
Confidential. Not to be copied, distributed, or reproduced without prior approval.
In-Vivo + In-Vitro Decision Making Therapy Innovation Therapy Delivery Monitoring
Precision Diagnostics Precision TherapeuticsPrecision
Monitoring
In-Vivo Diagnostics
In-Vitro Diagnostics
Clinical Decisions
Operational Decisions
Supply Chain
Image Guided Tx
Additive
Care Pathways
Research
Clinical Development
Technology PlatformsLeading platforms for delivering digital healthcare solutions
•Cloud•Edge•AI
With our partners, a leading portfolio of solutions that improve outcomes in priority care pathways
•Cardiology
•Oncology
•Women’s Health
•Neuro & Ortho
Acute
Mobile / Tele / Remote
Population Health
GE HealthcareIntelligence Suite C
yber
9
Strategicpartnership with
Cerebro
Buildingtowards
5 Feb 2019Enabling Precision Health
Precision Health
Confidential and internal. Not to be copied, distributed, or reproduced without prior approval.
Decision Making Therapy Innovation Therapy DeliveryIn-Vivo + In-Vitro Monitoring
Precision Diagnostics Precision Therapeutics Precision Monitoring
Protocol driven Too much data, in too many different places
Costly and risky R&D Complex and unguided Patients only monitored when sick
From
Highly personalized Integrated, longitudinal,fueled by AI
Precisely targetedclinical trials
Complex processes simplified. Precision
interventions. Additive
Pro-active approach to wellness beyond the
hospital
To
Each patient ... digitally connected
ExampleGE Healthcaresolutions Cerebro®
for Alzheimer’sLiver
ASSIST VI
Cardiac Ambulatory Suite
Oncologyand Acute Care
CommandCenter
MRAIRx
VenueShock Toolkit
10
The precision health journey
Confidential. Not to be copied, distributed, or reproduced without prior approval.
Q: How is GE accelerating its delivery of Precision Health? A: We’re partnering with leading innovators
11
… and many more
Clinical Partners Technology PartnersPharma/Medtech Leaders
5 Feb 2019Enabling Precision Health
Confidential. Not to be copied, distributed, or reproduced without prior approval. Roche-GE Collaboration 12
Partnering to build Tumor Board 2.0Convergence of NAVIFY and CENTRICITY Collaboration Suite platforms
GE CENTRICITY Collaboration Suite
PATIENT CASES
COORDINATOR
RADIOLOGIST
PATHOLOGIST
ONCOLOGIST CARDIOLOGIST
SURGEON
Organize and run cross-specialty sessions with centralized access to patient images and case data.
•Zero-Footprint Viewer (ZFP)•MDT preparation & administrative tools •Report templates
2017 20202018 2019
Workflow Products
NAVIFYTM Platform
Decision Support Apps (incl. AI)
Aggregated Data Insights
Growing portfolio of workflow and clinical decision support solutions
•Improved & adaptive workflow for multiple clinicians•Data driven patient and disease information to improve personalized patient care
ROCHE NAVIFY
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Precison Health
INTERACT Active Tracker active la synchronisation automatique des images entre les volumes U/S et CBCT 3D volumes, même lorsque le tracker est situé en périphérie du volume 3D.
Bénéfices :
Tracker détecté électromagnétiquement même lorsqu'il est situé à l'extérieur du volume CBCT, ce qui permet une couverture par imagerie plus flexible du patient.
Processus de fusion simple: détection transparente et automatiquedu tracker dans les volumes CBCT,transfert réseau vers LOGIQ E10, traitement automatisé du volume et co-enregistrement
Résultats : •Améliorer la productivité en RI,
•Tirer profit du CBCT comme un pont pour enregistrer l’Ultrasons
avec n'importe quelle image pré-op, même si acquis sans tracker, en utilisant la fusion multi-modalité sur AW•Améliorer la visualisation des lésions et le guidage de l'aiguille
en utilisant une grande variété d'images
Volume NavigationINTERACT Active Tracker
15
Traitement : Planification et Guidage
eTrax– Sécuriser le geste grâce au guidage virtuel
o Un capteur ré-utilisable permet de visualiser la pointe de l’aiguille à l’intérieur du patient
o Visualiser la trajectoire de l’aiguille et sa position exacte
o Guider des biopsies dans le plan et en dehors du plan de l’écho de façon plus rapide et plus sûre
o Prévoir et suivre le déroulement des interventions en synchronisation d’images avec des données fusionnées en temps réel
Guidage virtuel d’aiguille avec coaxial
Réel suivi de l’aiguille
Peut aider à réduire le nombre de redirection lors des procédures et donc l’essaimage de
cellules
Vivid E95
16
Understanding the Procedures
Vivid, cSound, XDclear, HDlive, EchoPAC, and ViewPoint are trademarks of General Electric Company.
Planning phase is key to the success of implanting the device specific to that patients anatomy
PLAN
Precisely position the device can be challenging and has an impact on regurgitations
GUIDE
Device deployment assessment & assessment of regurgitations
ASSESS
17Confidential. Not to be copied, distributed, or reproduced without prior approval.
Interventionel 17
Cardiologie:
Discovery IGS 730 & Vivid E95
Vivid CT FusionValve ASSIST 2
NEW
Sites: CHU Lille / CHU Rennes / CHU Toulouse / Cl Pasteur (Toulouse)
Congrès: SFCTCV (Rennes) juin; PCR – London Valve (nov)
Centricity™ Cardio EnterpriseMUSE™ Cardiology Information System
Precision Health and Aortic Stenosis
MAC2000Vivid™E95
Vivid s5StressEcho
Case exercisetesting
Discovery™IGS 730
ValveASSIST
2
Visipaque™&
Omnipaque™
Vivid E95 +Echo-Pac
MAC 5500 ECG
Revolution &Cardiographe
CT
Choose treatment based on valve function, severity of
symptoms and surgical risk
Plan procedure, best prosthetic match, based on
aorta and valve anatomy
Assess valve position and function after deployment, including fusion imaging
Screen for AS with ECG and echocardiogram
Monitor prosthetic valve hemodynamic status and detect
complications
Precision Diagnostics Precision TherapeuticsPrecision
Monitoring
In-Vivo + In-Vitro Decision making Therapy innovation
Therapy delivery Monitoring
Vivid E95 with Mitral
Valve Assess
Vivid4D
TEE
Revolution™ &Cardio-
Graphe CT
AW™TAVI
Analysis
GE PUPLIC
Precision Health and Stroke Care
Centricity™ Cardio EnterpriseMUSE™ Cardiology Information System
LOGIQ™ & Vscan™Ultrasound
IGS 630 Interventional
X-ray
Revolution™ CT &FastStroke CT
Application
Carescape™VC150
Algorithm Server+ ECG
recorders
Signa™ Premier MR Fast Brain protocol, 48
channel head coil
Visipaque™MR & CT Contrast agents
GRC Research
project
Venue™ultrasound &
AW FastShock
Accurate planning, rapid
lesionaccess, precise
assessment
Simplifies and organizes CT images for fast evaluation of
Stroke patients
Vital Signs Monitoroffering
seamless EMR connectivity
Accurate lesion confirmation and risk factor determination for 2° Prevention
Isosmolar contrast agent
Researching new
technologies for pre-hospital diagnosis
Simple, Fast, precise
diagnosis of shock
Precision Diagnostics Precision TherapeuticsPrecision
Monitoring
In-Vivo + In-Vitro Decision making Therapy innovation
Therapy delivery Monitoring
GE PUPLIC
• Preeclampsia is one of the leading causes of maternal and perinatal death worldwide and affects 2-5% of all pregnancies. It’s a frightening condition because it can come on suddenly and progress quickly
Clinical Innovation – Preeclampsia risk
Voluson imaging + ViewPoint 6 clinical algorithm
= Risk of Preeclampsia Precision Health
+ Biochemistry
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Precision Medicine & AI
Avalanche of data in healthcare
Fast and furious
Numbers5 KB / record
Text500 KB / record
2D Images1,500 KB / image
3D Images35,000 KB / study
Ultrasound20,000 KB / waveform
Video5,000,000 KB / movie
Hi-Res202, 375,168 KB / genome
New
Dat
a
TraditionalData
Growing at
48% per year2
of data per hospital150 Petabytes
1. “The Digital Universe Driving Data Growth in Healthcare,” published by EMC with research and analysis from IDC (12/13) 2. The upside of disruption, Megatrends shaping 2016 and beyond - EY
Document confidential. Diffusion et production interdites.
50 Pétabytes=
8 000 000 000 de livres=
533 fois la Bibliothèque Nationale de France
- Internal use only -
Must be stored for 5-25 years(average 10 years)
EB/ globally
5-25
IDC Health Insights, 2017
which is …
1024 Petabytes1,048,576 Terabytes
1,073,741,824 Gigabytes1,099,511,627,776 Megabytes
Exabyte1
~4.5
Confidential. Not to be copied, distributed, or reproduced without prior approval.
Why an Industrial Revolution | An Infinite AI Space
https://wsrs.org/2018meeting/handouts/allen_ai.pdf
• Physics• Anatomy• Function (fMR)• Pre/intra/post scan• Genomics• …
10987654321
1
0
9
8
7
6
5
4
3
2
1
Timeliness
Cost
- Internal use only -
Better computing
power
Availabilityof large
data sets
Better algorithms
Cloudservices
“In just seven years, the winning accuracy in classifying objects in the dataset rose from 71.8% to 97.3% surpassing human abilities and effectively proving that bigger data leads to better decisions.”
“AI is more important than fire...” Sundar Pichai, Google CEO, 2018
How an Industrial Revolution | Enter Deep Learning
72% 75%85% 88%
94% 97%
2010 2011 2012 2013 2014 2015
Be designed for the benefit, safety and privacy of the patient
Be a trustedsteward of thedata and insights
Be transparent and deliver robust and reproducible results
Guard againstcreating orreinforcing bias
GE HealthcareAI PrinciplesGE Healthcare will apply these AI principles to help improvehealthcare quality, cost, access and the patient experience,in the pursuit of Precision Health. AI Systems exist toaugment human intelligence, elevate clinicalcare teams and must:
Begin the Revolutionwith Values
Checklists/Metrics to Consider | Do you have the Volume?
Essential, but not sufficient
• Volume increases performance
• Volume must be “balanced”
• Annotation can drive volume needs
Checklists/Metrics to Consider | Do you have the Variety?
Variety prevents brittle AI
• DL models are data driven
• If only one data source is used, the model is likely “brittle” and not generalizable
• We’ve found # hospitals > data volume
• Seek diversity = geo, depart, vendor, socio/eco…
FoV Variability
Positioning Variability
Contrast Variability
Variety drives generalizability
Document confidential. Diffusion et production interdites.
a) Nouvelles applications, développées par GE Healthcare et nos partenaires cliniques.
b) Plus de 50 applications intelligentes déjà disponibles, couvrant les thématiques clinique, opérationnelles et financières.
34
a) Nouveaux ispositifs médicaux intelligents conçus pour améliore les workflows, la producivités, les diagnostics, et plus encore.
b) Possibilité de mettre à niveau certains dispositifs médicaux existants pour en augmenter les bénéfices.
• Imaging InsightsAn Edison application
Edison Platform
a) Permet aux équipes R&D de GE
Healthcare et à nos partenaires
stratégiques de concevoir, développer,
gérer, sécuriser et distribuer leurs
algorithmes et services rapidement.
b) Intègre un catalogue étoffé de services
de développement spécifiques pour la
santé.
c) Compatible avec tout modèle de
déploiement et d’exploitation : Cloud, on
Premise, embarqué.
Edison Smart DevicesEdison Applications
R&DDispositifs médicauxApplications
• OPTIMA XR240amxPowered by Edison
Edison | Create an AI factory that embraces everyone
Deployment TargetsData Source
2 Industrial Scale
AI and analytics in the healthcare system
Individuallevel
Enterprise level
Departmentlevel
Edison | Seamlessly embed AI in medical devices: X-Ray
Intended Benefit: Designed to deliver greater efficiency and better integrate technologists and radiologists
X-Ray technologist & care team alerted
*510(k) pending at US FDA. Not available for sale in the United States.
Why: Quickly identify and help prioritize critical cases such as Pneumothorax
Intended Benefit: Pneumothorax identification – designed to achieve high accuracy with (AUC >0.95)
Intended Benefit: AI point of care identification has the potential to expedite review by a radiologist of the critical findings.
On-screen notification & prioritization
Results sent to PACS
What: AI injected into device for real-time point of care support
2 Industrial Scale
38Confidential. Not to be copied, distributed, or reproduced without prior approval.
Interventionel 38
Liver ASSIST V.I.
Une solution complete pour:
-identifier les tumeurs
-Identifier les vaisseaux nourriciers
-prédire les différentes strategies d’embolization
Jusqu’à 97% de sensibilité dans l’identification des vaisseaux nourriciers, réduction de 11% du temps de procédure1 , et 68% de taux de réponse complète de la tumeur (vs 34% en DSA seule)
Simulation des embolisations en temps reel avant le traitementLiver ASSIST V.I. développé sur Edison
apporte une approche prédictive de l’interventionnel !
NEW
Edison | Seamlessly embed AI in medical devices: WH U/S
Benefit: Consistent measurements and significant workflow efficiency. (0:00-0:10)
Benefit: Prior to execution of the algorithm the users still possess ability to confirm placement. (Users really like this level of control)
Benefit: The system automatically acquires the required scans and measurements with precision every time.
User guides system to the fetal brain
Acquires accurate volume measurement, plans next scans
System executes the scans and final measurements
SonoCNS can help reduce keystrokes by 77%.
Enhancing user productivity and experience over time
2 Industrial Scale
Edison | Seamlessly embed AI in medical devices: MRMR AIRx™
Intended Benefit: Precise slice placement resulting in fast, consistent scanning
Rapidly identify Anatomical Landmarks
Intended Benefit: Consistent and accurate scans regardless of patient position, time between scans or technologist
Reduce rescans and workflow inefficiencies
https://medium.com/tensorflow/intelligent-scanning-using-deep-learning-for-mri-36dd620882c4
2 Industrial Scale
AIRx™ is Not Licensed in Accordance with Canadian Law. Not CE marked. Not available for sale in all regions.
Powered by a deep learning algorithm created from a database of 36,000 images
© 2018 General Electric Co.Advanced Visualization Applications for GE CT |
Bone VCARFirst GE CT deep-learning (DL) post-processing application
Algorithm tested on a database of 900+ different exams from a wide range of countries, scanner models and acquisition profiles:
•Different vertebrae coverage: cervical, thoracic, full spine…
•Different kV settings: 80, 100, 120, 140
•Different image kernel – standard, SOFT, DETAIL, BONE, BONEPLUS…
•Normal and abnormal datasets (see table)
Success Rate: 94.5% (test database)
97% (training database)
Examples With anomaly
Without anomaly
Artefacts Spinal implant, Bone cement, Dental artefacts, Beam hardening, low dose
103 389
Shape of the spine
Kyphosis, Scoliosis, Lordosis,
spondylolisthesis, patient posture
141 353
Shape of
the disc(s)
Herniated disc,
degenerative disc
149 349
Shape of the vertebra(e)
Osteophyte/arthritis, fracture, compressed fracture, spondylolysis
132 366
Density of the vertebra(e)
Osteoporosis, metastasis, bone cement
89 414
Anatomical variation
Lumbarization, sacralization, atrophied ribs
37 470
510(k) pending at FDA. Not available for sale in the United States.Not yet CE marked, not available for sale in all regions.
NEW
© 2018 General Electric Co.
Trusted results – provides highly accurate auto-processing of DICOM non-contrast head CT images using artificial intelligence for prioritization and triage of brain bleed
Powerful simplicity – auto-returns real-time, case-level signal and summary page to the CT scanner or PACS/RIS system stating if a suspected hemorrhage has been found
AbsoluteZero™ – zero clicks to initiate, zero need to leave the workflow, zero stored PHI, zero change to the images
Rigorously tested
Class II FDA-cleared medical device; CE approved; PHI compliant
Included with any GE Smart Subscription*
Advanced Visualization Applications for GE CT |
Accipio IxIdentify and triage NEW
Accipio Ix and AbsoluteZero are trademarks of MaxQ-AI. GE Healthcare is a licensed distributor of Accipio Ix.*Technologies in development that represent ongoing research and development efforts. This offering may not become a permanent offering and/or may not contain the products and its functionalities described herein
© 2018 General Electric Co.
From FBP to Iterative Reconstrucion thanks to Deep Learnin
1972 – 2008 The Era of
filtered back projection (FBP)
2008 – 2018The Era of
Iterative Reconstruction (IR)
2018 – FutureThe Era of
Deep Learning Image Reconstruction
Robust, fast and gold standard image quality at higher dose
Higher image noise and artifacts in low dose settings [1,2]
Maintain image quality while reducing the dose by up to 82% (vs high dose FBP)
Unfamiliar image texture produced by full strength IR. [1,2]
Achieve outstanding image definition, natural image texture, and low dose, all at
the same time.
- Internal use only -
Sagittal T2 FRFSERapid acq : 1 NEX
58sec
Sagittal T2 FRFSERapid acq : 1 NEX
58secDLRecon
Technology in development. Not cleared or approved by any regulatory body for commercial availability.
- Internal use only -Technology in development. Not cleared or approved by any regulatory body for commercial availability.
MR Excellence: Reducing patient waiting time for MR without sacrificing clinical quality
03:58
02:20
01:38
02:54
04:56
03:15
02:55
03:36
-16% -1mn56s
Dr. Christopher Ahlers Managing Partner, radiomed
Estimated 260,000 € per year per machine benefit*Reduced patient waiting time from 6 to 2 weeks for certain exam
types
Optimize a protocol for efficiency
Before After
BEFORE AFTER
MR1.5T – Cervical Spine example
Cannot sacrifice the clinical outcome
Proven and Improved Workflow
Average Number of exams/week
+46exams/week126
jan.-17
Initial phase
172
mar.-17
Final phase
feb.-17
146
Sag T2
frFSE Sag
T1 FSE Cor
STIR
Ax T2 frFSE
Ax Cube T2
* - Using patient public reimbursement rate in Germany. Results listed here are of this specific customer and may not be typical. Results are based on factors specific to
each customer. GE cannot guarantee these or similar results.
Command Center: Transforming clinical operations through artificial & human intelligence
8%increase in
daily ED Visits1
45%reduction in
inpatient clean bed waiting
time2
23equivalent
beds added3
Predictive analytics and systems engineering to better managepatient safety, experience, volume, and movement of patients.
GE plans to announce 10 new command centers covering 30 different hospitals—which, over five years should yield those medical centers a roughly 4 to 1 ROI.
1. CIHI NACRS ED Activity Reporting, 2. HRH Housekeeping System Data Extracts, 3. CIHI DAD Inpatient Reporting, Acute Conservable Bed Days
Humber River Hospital, Toronto, Canada
- Internal use only -
Takeaways:
Our customers have to start tackling their data.
[Data quality – Data management – Data analytics]
- Internal use only -
Rapid development ...
2020 2027 2032
Deep Learning algorithms will be able to create reports for mammography and chest x-ray exams.
CT of the head, chest, abdomen, and pelvis; MR of the head, knee, and shoulder; and ultrasound of the liver, thyroid, and carotids.
Within 15 to 20 years, deep-learning algorithms will be able to produce reports for most diagnostic imaging studies.
Dr. Bradley Erickson, PhD, from the Mayo Clinic, Rochester, MN. May 25th 2017, panel discussion at the U.S. National Cancer Institute (NCI) Shady Grove Campus in Rockville, MD.
- Internal use only -
+
… or Man w/ Machine vs Man w/o Machine.
Geoffrey Hinton
“You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete.”
– Buckminster Fuller