TOP TECHNOLOGY FOR PATIENTS

BIOMEDICAL TECHNOLOGY AND TECHNICAL MEDICINE

MIRA

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MIRA Photo: Gijs van Ouwerkerk

At the MIRA research institute, we are

convinced of the power of collaboration.

The interview with ir. Jeanine de Regt

and mrs. Elra Eppink of the CMI Twente

Innovation Cluster for example, illustrates

how collaboration accelerates the inno-

vation process. Another fine example:

professor Wiendelt Steenbergen’s

collaboration with a team of students,

doctoral candidates and researchers has

resulted in winning the Audience Award

of the Annual Academic Award. Shortly

thereafter, Steenbergen, along with

spin-off company PA Imaging BV and

the hospital Medical Spectrum Twente,

was nominated for the Herman Wijffels

Innovation Award 2013 for the research

on Pammography.

Technical MedicineWe are very proud to announce that with the inclusion in Article 36a of the Individual Health Care Professions Act (Wet BIG), the government and the medical profession confirm their faith in the skills of our technical physicians. Technical Medicine at the University of Twente is the only technical medical degree programme in the world in which students can obtain a qualification to treat patients indepen-dently. A technical physician can use the technical innovations in the healthcare sector in the best possible way in order to improve a patient’s health and safety. In this edition of MIRA Magazine, dr. Linda de Wit-Van der Veen, alumna of the Technical Medicine programme, gives a behind the scenes look at the work of a technical physician in the hospital. Also worth noting: Paradoks, the study association of the Biomedical Technology and the Technical Medicine educational programmes, is celebrating its 35th anniversary.

MIRA highlights In this magazine, you’ll be updated on a large grant which was awarded for diabetes research, highlights from the research of professors Karperien and Grand-jean, and more on the Mindwalker project of professor Herman van der Kooij. You will also read about MIRA’s successful spin-off company Materiomics and the new Executive Master of Business Innovation & Entrepreneurship in Health. Finally, you can read about Scientific Director Vinod Subramaniam’s farewell. With his departure to the FOM Institute of Atomic and Molecular Physics (AMOLF), MIRA is saying goodbye to a highly valued colleague and scientist. The position of Scientific Director will be temporarily filled by Professor Maarten IJzerman, head of MIRA’s research group HTSR and founder of High Tech Health Farm (HTHF): an ambitious project in which the province of Overijssel and the University of Twente collaborate with research insti- tutions, hospitals and industry. Within this successful collaboration which will conclude at the end of 2013, a dozen new biomedical technologies have been developed for the improved treatment and diagnosis of patients. Furthermore, the collaboration with Roessingh Research & Development was given a boost with the signing of a strategic cooperation agreement, earlier this year. In short, innovation is achieved together! Not entirely coincidentally, this theme also runs through the event we are organizing together with Technical Medicine on 19 June 2014.Are you curious to find out how we can strengthen each other? Please save the date and stay apprised of the programme via our website www.utwente.nl/mira.We look forward to seeing you!

INNOVATION AND THE POWER OF COLLABORATION

Photo: Gijs van Ouwerkerk

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Technological innovation in cardiac surgery

mainly entails developing new surgical

techniques. Grandjean believes we can

work in a far more predictable fashion in

the field of cardiac surgery.“The direction

we aspire to involves pre-operative risk

modelling of cardiac surgery outcomes.

A heart is very dynamic, but when you

work on or in it, the motion of the heart

must be stopped. The surgical outcome can

only be determined once the heart’s blood

flow and movement have been restored.

I say: stop the trial and error and use

software to pre-process the images so

that you can predict the final outcome.”

Bypass and mitral valve surgeryGrandjean has been performing surgery on beating hearts for nearly twenty years now. The Thorax Centre is a leader in the field of beating heart surgery. Over 80 percent of bypass operations in the Thorax Centre are performed on a beating heart; nationally, that figure is less than 20 percent.

In cardiac surgery, the radial artery (one of the two arteries in the lower arm) has been used for some time now for coronary artery bypasses, instead of a vein from the leg. A pilot study is currently conducted which uses the Twente Optical Perfusion Camera

(TOPCam); this pilot will give surgeons more insight into surgical outcomes. Grandjean’s research goal is to be able to perform heart valve repair surgery without stopping the heart, just like during bypass surgeries. In this way, the mitral valve (the inlet valve between the left atrium and the left ventricle of the heart) could also be repaired using this method.“Leaking heart valves need to be repaired and the surgery for that will be performed on a beating heart, guided by echocardiography. This is a very complex and difficult procedure. Across the medical world, people are looking for a solution for more predictable surgical outcomes. This also applies to surgery for leaking heart valves. MIRA is playing an important role in this project.”

Creating aortic valves with 3D printingGrandjean also conducts research into new aortic valve surgery techniques. Work is being done on converting images from an echogram, MRI or CT scan with technology like CAD software. In this way, the surgeon knows exactly what to do if the patient is on the operating table and the heart-lung machine starts to work. As soon as there is a decrease in aortic pressure, which is required to open the aorta, all of the dynamics and geometry disappear. UT researchers have recently been able to make a 3D print of a normal aorta or valve, as well as abnormal valves. Grandjean: “If the surgeon can examine a similar heart valve model in advance, this will already provide substantial information.”

CollaborationGrandjean collaborates with many other MIRA research groups. The department of Robotics and Mechatronics for example, is involved in the develop-ment of steerable catheters which can be correctly placed by a computer. Technical Medicine and Biomedical Engineering students are working on assignments in this area.

NEW TECHNOLOGIES FOR CARDIAC SURGERY

Cardiac surgery is on the eve of some

very important technological innovations,

according to Jan Grandjean, part-time

professor at the University of Twente

and cardiothoracic surgeon at the Thorax

Centre of the Medical Spectrum Twente.

Grandjean gave his inaugural lecture

last spring. “Thanks to technology,

we are gaining more insight into our

medical practices. Cardiac surgery has

a demonstrable need for these clinical

insights.”

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In The Netherlands alone, more than 150,000

people have type 1 diabetes. Regenerative

medicine could mean a world of a difference

to these people. Under the motto “One donor

for one patient”, dr. Aart van Apeldoorn

is working on technology for the optimal

transplantation of “islets of Langerhans”

which are clusters of insulin-producing

cells. His research group was recently

awarded a grant from the Juvenile Diabetes

Research Foundation (JDRF) worth over

$US 1 million (see text box).

Roughly one million islets of Langerhans, small clumps of specialized cells, are distributed throughout the pancreas. One of the hormones produced by the islets is insulin, which regulates blood sugar levels. With type 1 diabetes patients, their body’s immune system sees the islets as foreign bodies and it attacks and destroys them.According to van Apeldoorn, of the Developmental Bioengineering research group of MIRA, for patients suffering from type 1 diabetes, it is often a daily struggle to cope with the disease. “Just imagine: these patients - often still children - have to check their sugar blood levels multiple times each day by pricking their finger with a lancet; they have to count every calorie and carbohydrate that they consume and they have to take regular insulin injections. Moreover, the long-term effects of poor sugar metabolism are not good. For example, type 1 diabetes patients are at an increased risk of developing blindness, kidney failure and poor blood vessel health, especially in the lower legs, which can even lead to amputations.”

TransplantationTransplanting islets of Langerhans can be a solution for type 1 diabetes patients, and this has been implemented on a very limited scale for about eleven years now. However, there are some disadvantages associated with this procedure, including that many of the islets die very soon after transplantation.

Van Apeldoorn: “At present, the islets are transplanted into the liver via the portal vein, which is very inefficient. About 60 percent of the islets degrade within the first week.”Therefore, van Apeldoorn and his research group are working on new transplantation methods for the islets. “It all revolves around the question: how can I create an environment which will give the islets the highest possible chance of survival? With 60 percent degradation, patients now require two to three islet transplantations to achieve insuline independence. If you are able to perform islet transplantation in a better environment, fewer transplantations will be required. We all know that there is a donor shortage, so it would be amazing if we needed less donor material per patient. Our motto is: One donor for one patient.” Two projectsVan Apeldoorn is working with various partners on two major research projects to find solutions. For both projects, van Apeldoorn is developing so-called scaffolds: polymer carriers, which can be used to transplant the islets isolated from a donor pancreas to a place other than the liver. One project involves an “open structure” carrier. The advantage of this carrier is that it is easy for the blood vessels to grow into the structure to provide the islets with oxygen and nutrients. Because islet transplantation is already an approved medical therapy, and the materials being used in this project are generally approved for other medical applications, van Apeldoorn expects this method to be clinically applicable in the foreseeable future. Incidentally, van Apeldoorn stresses that, due to safety requirements for medical innovations, a period of ten years is not unreasonable. “Patient safety comes first. Obviously new implants must first be thoroughly tested.”

Closed structureEven though the development of the “open carrier” represents a very big step for patients suffering from type 1 diabetes, it is certainly not a final solution. The disadvantage of this approach is that the patient will be dependent on medications in order to prevent the rejection of the foreign donor cells. “These drugs have a lot of adverse side effects, especially if you use them for a long time, which patients have to do, given that they have received cells from a different person.”Therefore, van Apeldoorn is working on another project on a completely different type of carrier, namely with a closed structure. “We are trying to create closed structures in which the recipient’s cells have little interaction with the donor material, and yet

ONE DONOR FORONE PATIENT

Aart van Apeldoorn works on technology to combat type 1 diabetes

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are open so that oxygen and nutrients can penetrate by diffusion, and insulin can leave the structure.”The patient, in principle, does not have to use any medications against rejection with closed structures. An additional advantage, according to van Apeldoorn, is that it might even be possible over time for the structures to be used in xenotransplantation, in which you can transplant, for example, islets of Langerhans from pigs to humans, but more research is obviously required.

MembranesVan Apeldoorn is working on closed structures made of membranes that consist of several compartments. Each compartment is given its own function. Van Apeldoorn: “You might create a closed compart-ment for the islets and another compartment that is very open for blood vessels to grow into. In addition you can make a compartment in which you place other cells with different functionalities or growth factors.” “Since we use oxygen generating materials, we hope that the islets can withstand the first phase of implan-tation when there is not yet enough blood vessel growth. Once blood vessels grow around the implant,

they can (through diffusion) ensure that the islets get enough oxygen.”Van Apeldoorn is still researching the most efficient shape for the carrier. He is working on two different types of structures: hollow fibres and flat membranes. “The hollow fibres actually look like thin straws which contain several thin channels.” Van Apeldoorn compares the flat membranes to envelopes. Both configurations have their own advantages. “You can easily stack flat structures, but fibres roll up well, and therefore are easier to insert with minimally invasive surgery. Ultimately, the question is what the surgeon prefers to use in the clinic and which structure the islets function best in.”

It can be doneBecause the second method is more complicated, and new manufacturing techniques may well have to be developed, it will probably take longer before this method can be applied. Van Apeldoorn is convinced that both methods have a good chance of success in clinical practice. “I think it’s important that a solution for type 1 diabetes is found. And I’m convinced it can be done. It is a disease for which a solution can be found through good research.”

Photo: Gijs van Ouwerkerk

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$US 1 million grant from JDRFRecently van Apeldoorn received a grant of more than $US 1 million from the Juvenile Diabetes Research Foundation (JDRF) for his research. JDRF is the leading global organization for scientific research into the cure, prevention and treatment of type 1 diabetes. Since its inception in 1970, JDRF has funded more than $US 1.7 billion in research into type 1 diabetes, in 27 countries.

The JDRF grant allows van Apeldoorn to do more than just fund his research. It opens doors in other areas. “JDRF is very good at bringing patients and scientists together. In addition, JDRF also opens doors to new research collaborations. In the consortium, you work with internationally-respected type 1 diabetes researchers who have participated in the field for a long time. We are a relatively young research group, so it is nice that we can draw from their experience.”

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MIRAMIRA

After studying Chemical

Engineering at the

University of Twente,

Bernke Papenburg obtained

her PhD with the Membrane

Technology Group, in

collaboration with MIRA’s

Tissue Regeneration

Department. The focus of

her PhD research was

scaffolds as supports on

which cells can be grown.

Then Papenburg completed

postdoctoral research in

Boston into biomedical

implants made of natural

silk. When she was asked

if she would be a project

manager for Materiomics,

she returned to the UT.

She has filled this position

for more than three years

now.

Materiomics Materiomics was founded in 2009 by MIRA professors Clemens van Blitterswijk, Jan de Boer and Frank-Jan van der Velden and now has more than six full-time employees. This spin-off of the MIRA research institute has developed a unique technology to research and influence the behaviour of, for example, stem cells: the TopoChip. Papenburg: “The TopoChip consists of 4,400 compartments which are a few hundred microns in size, and which differ only in their surface structure. Cells attach within the compartments, and they develop in different ways due to the different surface conditions in the compartments. The TopoChip provides insight into the specific circumstances under which, for example, stem cells can develop into specialized cells such as bone or fat cells. You can also infer which structures cells adhere better to and which structures result in non-attachment.”

INFLUENCING BIOLOGICAL PROCESSES AFFECTS THE STRUCTURE AND SURFACE

AREA OF MATERIALS

Materiomics uses this knowledge to develop materials for specific, mostly medical, applications in which cell adhesion is or is not desirable. “For example, we conduct research on structures which blood platelets are not able to attach to: this is very valuable, for example, for intravenous catheters. The opposite is also possible: we can develop surfaces which cells are definitely able to attach to. Regarding these, you can think of hip implants with a textured surface which promotes the adhesion of the body’s own cells. The interaction between the surface and the biological environment can, for example, ensure that stem cells are attached to it and develop into bone cells. The improved fixation of the implant in the body means that a “restoration operation” - now performed often after ten to fifteen years once the implant begins to detach - can be postponed or may even become unnecessary”, according to Papenburg.

High Tech Human TouchThe opportunities for the application of this high tech screening technology seem inexhaustible. Although Materiomics currently specializes in surface development for the biomedical industry, Papenburg has not ruled out other markets: “This knowledge may be of value in many other markets. Think of the profit you could earn by reducing the resistance of pipes or sewers to water flow. The technology is there, only the area of application is different.”

Materiomics - UT collaboration“We are, as a spin-off, supported in many ways by the University of Twente and this remains an intensive collaboration”, said Papenburg. “Jan de Boer is an important link to the department in which the fundamental research is being conducted. It is in this department that insights are gained into the underlying processes influencing cell development. Materiomics translates this know- ledge into a socially-relevant commercial product.”

FP7Papenburg closes: “We have worked very hard with the team to standardize our processes, experiments and the storage of screening results in a database. Thanks to our various backgrounds (from biology to materials science and computer science), we have managed to develop a platform that is future-proof.” The developments within Materiomics have not gone unnoticed. The company is already taking part in an ongoing FP7 project and joins an European consortium that will start a new project for human stem cell research in 2014.

Photo: Gijs van Ouwerkerk

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You inject a ‘liquid plaster’ into the worn-out knee of an osteoarthritis patient. The plaster hardens in the joint and attaches to the damaged cartilage, then it induces the body to repair the damage. A few weeks later the patient is once again able to walk pain-free. This is the ideal Professor Marcel Karperien of the University of Twente’s MIRA research institute envisions. An ideal that he believes could be realized within a few years.

Thirty percent of the Dutch population will struggle with osteoarthritis at some point in their lives. It is a typical disease of old age and therefore, more and more people will face it in an ageing population. There is also a growing group of people who suffer from limitations caused by osteoarthritis at an early age, for example as a result of a sports injury such as torn cruciate ligaments or meniscus damage. Osteoarthritis causes cartilage in the joints to deteriorate and in some cases to even disappear completely. There is still no cure for the disease; current treatment is designed mainly to relieve the pain. Some patients are given artificial joint replacements. UT professor Marcel Karperien, from the department of Developmental BioEngineering, is working on a new treatment method that could completely cure the condition. “The prevailing dogma in science is that cartilage,

which acts like a shock absorber in a joint, is unable to restore itself.” But this dogma will soon be demolished once and for all, says Karperien: “Cartilage has an intrinsic self-healing capacity. We just need to ensure that we can tap into that ability. That requires a multidisciplinary ap-proach, combining knowledge from developmental biology and medical science with high-tech technology.”

Injectable plasterKarperien is working on a method which involves injecting a bio-material containing the patient’s own stem and cartilage cells into the joint. This injectable plaster expands in the space where the cartilage has been lost, creating an environment in which the damaged cartilage can repair itself. After a while - once the damaged cartilage has been repaired - the body breaks down the biomaterial automatically. Laboratory research

and initial tests on laboratory animals show that the basic technology works. Though the ultimate research goal is to help people with arthritis, the veterinary sector can also benefit from Karperien’s research. He first wants to test the treatment method on animals, such as racehorses with a knee injury. Karperien: “This will not only help the animals and their owners, you also gather relevant knowledge, which can be used in the future once we begin treating human patients.” For his research, Karperien is working closely with the Den Ham Animal clinic and Utrecht University’s Faculty of Veterinary Medicine.

Cell-free plasterProvided the follow-up experiments go well, Karperien expects that the method will be able to be used for the first time on osteoarthritis patients in an experimental setting in a few years’ time. “Eventually we can probably even create a cell-free plaster (without cartilage and stem cells from the patient) that orchestrates cartilage repair.” The technology could also be used to repair other organs, at least in theory. Researchers in Karperien’s department are working on methods for using the liquid plaster in spray form to heal skin wounds, or transplant islets of Langerhans to cure type 1 diabetes. (see also p. 4-5)

INJECTABLE PLASTERS:

THE FUTURE FOR OSTEOARTHRITIS PATIENTS

MIRA

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MIRABIOMEDICAL TECHNOLOGY AND TECHNICAL MEDICINE

13427 MIRA advertentie A4.indd 1 04/12/13 13:50

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After graduating from the UT, de Wit-Van der Veen achieved her doctorate in record time - roughly two years - from Leiden University Medical Centre (LUMC) with her doctoral research, where she also completed her final project. Meanwhile, de Wit-Van der Veen has worked for over a year as a postdoctoral fellow at the department of Nuclear Medicine of the Netherlands Cancer Institute (NKI-AVL). This really suits her, especially because the work is so varied. “For example, I begin today with a half day at the clinic where I work with the patients and write up my reports. This afternoon, I’ll be back in the animal lab for research. I really enjoy combining clinical work with research.”

De Wit-Van der Veen’s work in the hospital consists grosso modo of three parts, she says. “Of course, I provide support in the clinic, which really increases my knowledge. I also perform many tasks for Clinical Physics such as quality control of the scanners, taking phantom measurements and ensuring that the scanners are working properly. If there are any problems, the laboratory technicians approach me first. In addition I am involved in coordinating the scientific research. There are many studies in the hospital that use departments such as Nuclear Medicine. My experience in this is often highly appreciated.”

Technical MedicineDe Wit-Van der Veen looks back on at her time studying Technical Medicine at the UT positively. She believes she benefited the most from the way the UT teaches critical thinking. “You really stand to benefit from this critical thinking. For my clinical work, naturally, it would have been easier if I had been a doctor because then I would already have broad knowledge of diseases and medications. Those are the things which I need to learn more about now. However, because I gained considerable experience in research, engineering and technology during my education and PhD research, it is easier to learn these things and to combine those two aspects. In terms of clinical work, I sometimes feel that I do not have enough knowledge, but if you look at the big picture, I received a very good education.”Because Technical Medicine is relatively new, many graduates of the programme still have to establish themselves in the medical world.

“This was not an issue for me in the department where I work now, because they were already accustomed to technical physicians”, the postdoc explains. “But in Leiden, I did experience some misunderstanding in the beginning. When I graduated from Leiden, I was the first technical physician to have studied there. You often have to explain exactly what type of student you are. It certainly helped that many of my colleagues in the department of Nuclear Medicine were very open to learning about my background. When I speak with the UT students of today, I get the impression that they experience much more acceptance. To me, technical physicians already seem quite established, in the academic hospitals and the larger general hospitals in particular.”

The only thing de Wit-Van der Veen is still waiting for is the much anticipated BIG registration. “I hope this is settled quickly. The registration should provide for some more acceptance and for better positioning in the hospital. At present, it can be difficult to catego-rize us technical physicians. This can, for example, present problems when it comes to receiving a per-manent contract. This will all proceed more smoothly once the BIG registration has been established.”

After the interview the Dutch government accepted changes to the Individual Health Care Professions Act (Wet BIG), which qualifies Technical physicians for five years under the protected title of Clinical Technologist. It allows them to perform medical procedures, such as surgical procedures, catherizations and endoscopies. Technical Medicine at the University of Twente is the only technical medical degree programme in the world in which students can obtain a qualification to treat patients independently.

PROF. DR. G.P. VOOIJS AWARDDe Wit-Van der Veen was awarded the first Prof. Dr. G.P. Vooijs Award for her final project. This prize is awarded to the most clinically relevant final project. The prize, which from now on will be awarded annually, is named after Peter Vooijs, who served as the Medical Director of the MIRA research institute and as Scientific Director of the Technical Medicine educational programme for the UT for years.

TM ALUMNA IN THE SPOTLIGHT: LINDA DE WIT-VAN DER VEEN

Linda de Wit-Van der Veen completed

her education in Technical Medicine (TG)

at the University of Twente in 2010.

She looks back on her education and

talks about her career for MIRA Magazine.

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MIRA

PAMMOGRAPHY RESEARCH IN THE SPOTLIGHT

The Biomedical Photonic Imaging research group

(BMPI), headed by MIRA’s professor Wiendelt

Steenbergen has received a lot of attention this fall.

The BMPI research group managed to get through

to the final of the Annual Academic Award

(Academische Jaarprijs) and, along with UT

spin-off PA Imaging R&D BV, has been nominated

for the Herman Wijffels Innovation Award 2013.

Annual Academic Award 2013Under the name “Team Steen-bergen”, a team of scientists and students from the MIRA research institute has made it to the finals of the Annual Academic Award 2013. The award (€100,000 in prize money) is given to the team that best manages to make scientific research accessible to a wide audience. In addition to the team from Twente, two other teams were competing for the prize, which eventually was won by the University of Amsterdam. Twente, however, received most of the votes from the audience, and has won the Audience Award. This means that the team has contributed a question and a demonstration experiment for the National Science Quiz 2013, that will be broadcasted on national tv on 29 December.

The Twente team has won a place in the finals (out of 17 participants) for its plan - entitled “You can hear tumours” - to introduce secondary school students to the possibilities of photoacoustics in an accessible manner. Photoacoustics is a tech-nology that can reveal tumours using light and sound waves.Steenbergen, head of the BMPI research group and Track leader of MIRA’s Strategic Research Orientation on Imaging & Diagnostics, illustrates the team’s goal: “Secondary schools focus more on science and technology these days. By participating, we aim to inspire youngsters about science and technology before they choose their subject cluster. The challenging practical we have developed for the students integrates the social relevance

in education with the physical principles of photoacoustics.” The team would have used the prize to implement the practical for pupils in the third year of pre-university education.

Herman Wijffels Innovation Award The BMPI research group and UT spin-off company PA Imaging R&D BV were nominated for the Herman Wijffels Innovation Award 2013 concurrently. The Herman Wijffels Innovation Award is a lead-ing incentive award for sustainable innovation in the Netherlands. Every year, entrepreneurs are given the chance to actually realise their sustainable innova-tions. This year, the jury selected a total of 13 entrepreneurs from the record-breaking number of entries, 743, as nominees.

“Pammography”PA Imaging and UT researchers are working on a completely new technique for detecting breast cancer. The technique, which has been named “pammography”, uses short light pulses that cause ultrasound in areas with a lot of blood, such as around malign tumours. With mammography, the customary detection method that makes use of X-rays, it is very difficult to discern tumour tissue from glandular tissue in young women. Since this is not the case with pammography, this technique could introduce the concept of breast cancer screening for women under 50. Another advantage is that the technique does not cause pain because, unlike with mammo-graphy, breasts do not have to be compressed.

PA Imaging-MST Hospital collaboration PA Imaging was set up in late 2010 and was financed with venture capital from the public-private incubator fund UT International Ventures. The unique collaboration between the UT knowledge institute, with PA Imaging - an SME company, and specialists from MST Hospital in Twente, has resulted in the collection and comparison of clinical data of more than 60 patients, which serves to further substantiate the effects of pammography used in practice. The results indicate that with pammography, tumours can be detected that would be overlooked with classic X-ray screening (fewer so-called false negatives).

Photo: Gijs van Ouwerkerk

For prof. dr. ir. Herman van der Kooij from the University of Twente and the Delft University of Technology (TU Delft), the point of departure for the Mindwalker project was to allow disabled people to walk just by thinking about it. The researchers, in the meantime, have already advanced a step further: “It is better if the apparatus is steered by the upper body, because what people in a wheelchair need, is movement.”

The Mindwalker is a robot suit, an exoskeleton, which not only supports people with physical disabilities, it also allows them to walk again. According to van der Kooij, the system could help thousands of people over time. He is thinking, for example, about people confined to a wheelchair due to paraplegia or a cerebral haemorrhage.

Several international universities are collaborating on the Mindwalker project, which began in 2010 and is financed by the European Union. The exoskeleton was named the Mindwalker because the original intention was to steer it via a helmet with electrodes placed on the patient’s head. The electrodes had to receive the patient’s brain signals and transmit them to the legs. This would allow the patient to set the robot legs in motion simply by thinking about walking.

Initial testsThe initial tests for the first prototype were recently conducted in Rome, with able-bodied subjects and with paraplegic patients. According to van der Kooij these tests were successful. “The prototype functioned well. We have tested several steering methods, including steering by tensing the arm muscles and by using brain signals.Both methods worked, but in practice it proved very cumbersome to pick up the “walking thought” well enough, and quickly enough.”

Eventually, a steering method was chosen in which the patients set the exoskeleton in motion by moving their centre of gravity. According to van der Kooij, this is a more natural steering method. “Able-bodied people also unconsciously use this method when walking. Another practical argument for using the upper body to steer the exoskeleton is that people confined to a wheelchair benefit from moving.” During the tests, the able-bodied trial subjects were able to walk with the exoskeleton without crutches; the patients, however, still required crutches.

Follow-up projectTo develop the exoskeleton, van der Kooij is working on the hardware of the suit at TU Delft, whereas the University of Twente is developing the steering method. The next step for the steering development is to ensure that it is intuitive and results in a stable walking pattern which does not require crutches. Another important next step is to make the system lighter. The exoskeleton currently weighs 23 kilos. This is already a technological feat in itself because the suit must be able to withstand enormous forces and is equipped with motors. For the follow-up project, Symbitron, which began in October of this year and which van der Kooij is also coordinating on behalf of the University of Twente, researchers are working on improving the steering and a further reduction of the suit’s weight. Van der Kooij hopes that the final version of the apparatus will be lighter by a factor of three.

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Photo: Kees Bennema

ROBOT LEGS ALLOW DISABLED PEOPLE TO WALK AGAIN

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With the new Executive Master of Business Innovation & Entrepreneurship in Health (MBI Health), the University of Twente, Utrecht Life Sciences, UMC Utrecht, Radboud UMC and UMC Groningen have started a joint, multidisciplinary educational programme that connects care technology with entrepreneurship. The initiative is aimed at preparing entrepreneurs to bring their promising health care innovations to fruition faster. This will help the patient to benefit from the new healthcare technology sooner.

Already in February 2014, the first 20 - 24 participants will begin with a strongly internationally-orientated “experience-based” training programme, to which other renowned universities in the United States and Europe are also making important contributions.For the development of this prestigious initiative, the Netherlands Genomics Initiative (NGI) awarded the collaborating knowledge institutes a commercial knowledge transfer award of €275,000. These funds will be used in part to set up a “revolving fund” intended to guarantee participation of young start-ups and commercial knowledge transfer experts from research institutes for the coming years.

Unique ecosystemEstablished names from the Biopharma industry from all over the world have committed themselves to the programme, creating a unique ecosystem that should ensure that care innovations are brought to the market faster.

According to professor Marianne van der Steen, academic director of the education programme, there is a need for the executive master: “It is in the interest of the patient that relevant care innovations are brought to the market as quickly as possible.

However, this requires new forms of collaboration and co-creation. In this education programme, the participants from business, spin-off companies, academic hospitals, knowledge institutes and insurance companies, learn how to accomplish this on the basis of concrete joint business cases. The programme goes a step further than just marketing knowledge, participants learn the skills to develop health innovations into effective solutions for patients.”

Entrepreneurs of the future“This initiative, aimed at strengthening innovation and entrepreneurship, connects quite well with the University of Twente’s High Tech, Human Touch profile. Investments are made in the leadership abilities and the business cases of the entrepreneurs of the future. It is our ambition in the coming years to build an internationally- recognized MBI Health with a global participation field,” according to dr. Martijn Kuit, managing director of MIRA.

Participant dr. Bernke Papenburg (see interview p.6) adds: “This executive master seamlessly matches the needs of Materiomics. For a spin-off company in the start-up phase, the combination of an international network, a direct link between the business develop-ment activities and our own cases, and coaching from enthusiastic and highly renowned experts, is of great value. I’m really looking forward to starting this unique programme.”

Van der Steen closes: “At the moment, we still have room in the programme for one more venture team, before the start in February 2014. So, if you’re interested, be quick!”

More information about the programme and contact information is available on the website: http://mbi-health.com

Photo: Gijs van Ouwerkerk

Knowledge institutes launch

master’s programme to market

health care innovations faster.

BUILDING A GLOBAL HEALTH ECOSYSTEM WITH ENTREPRENEURIAL IMPACT

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On 28 August the MIRA Biomedical Technology and

Technical Medicine research institute bid a fond farewell

to its Scientific Director Vinod Subramaniam. He has done

a great deal for MIRA. Whenever possible, he capitalized

on opportunities to connect the University of Twente’s four

research institutes, based on their individual expertise and

at the intersection of disciplines. Not entirely coincidentally,

his Nanobiophysics research group participated in both

the MESA+ Institute for Nanotechnology and in MIRA.

A year ago Subramaniam launched the MIRA Distinguished Lecturer Series: a series of lectures de-signed to connect MIRA’s bio-medical research to the outside world. Topics at the forefront of science are presented in lectures by distinguished researchers in the field that specifically target MIRA’s broad audience. Each lecture is preceded by a lecture of a talented UT researcher.

Talent developmentSubramaniam became Director of the FOM institute for Atomic and Molecular Physics (AMOLF), and group leader of the Nanoscale Biophysics group in September. He has been widely praised for his passion, open mind and personal involvement in the development of young scientific talent. Below is a sampling of the praise that Subramaniam received during his farewell party:

Father to MIRAProfessor Ed Brinksma, rector magnificus of the University of Twente, expressed the following: “Besides excellent research, you are a citizen of the world with broad academic interests. Tenure tracks were on your agenda, and we would often debate university policy. As much as we regret that you’re going, we understand it. We are grateful for all that you’ve done… and you have made a name for the institute. You will always be a father to MIRA.”

Magnet for talentProfessor Gerard van der Steen-hoven, dean of the faculty of Science & Technology added: “Vinod has a remarkable talent to think the other way around.

He thinks of what the other guy might need, and how he could help this person. How often have I heard individual students and tenure trackers say: “I felt stuck, not knowing what my next step should be. But I talked to Vinod… he gave me such and such advice, and now I am back on track.”

Also typical for Vinod: out of your initial research group, three fully developed groups have originated. You have a way of attracting talent and binding it to you, and thereby to the faculty and the University. I thank you for that!”

Hans Hilgenkamp, Professor of Physics at the Faculty of Science

and Technology and the MESA+ Institute for Nanotechnology stated: “You radiate a friendly atmosphere which flows through the discipline of physics and beyond, and all through the faculty of Science and Technology and the University as a whole. This friendly atmosphere even radiates on a national scale, from your work as chair of the National University Groups in the field of physics (Plat-form Universitaire Natuurkunde).”

An offer you can’t refuseStaff from Subramaniam’s Nano-biophysics research group, now led by dr. Mireille Claessens, emphasized Vinod’s personal support and commitment to the researchers. Finally, Subramaniam gave a brief statement: When an offer you can’t refuse comes along… you take it! It came along and I simply couldn’t refuse.

We wish Vinod a wonderful continuation of his career at AMOLF.

FAREWELL TO AN INSPIRING SCIENTIFIC DIRECTOR

SUBRAMANIAM’S SCIENTIFIC CAREERVinod was trained in Electrical Engineering and Applied Physics (Cornell University, Ithaca, New York and the University of Michigan, Ann Arbor, Michigan). After receiving his PhD in 1996, he joined the Max Planck Institute for Biophysical Chemistry in Göttingen, Germany as a postdoctoral fellow in Dr Thomas M. Jovin’s research group. He was awarded an Alexander von Humboldt fellowship and a long-term fellowship with the Human Frontiers Science Program. He stayed at the Max Planck Institute until 2002 as a staff scientist and group leader. In 2002 he joined the Advanced Science and Technology Laboratory of AstraZeneca in Loughborough, UK as a senior research scientist. In 2004 he was appointed professor and chair of Biophysical Engineering at the University of Twente, followed by a position as scientific director of the MIRA research institute, in 2012.

His work has been recognized with a Fluorescence Young Investigator Award from the Biophysical Society. Amongst other functions, Vinod was chair of the FOM workgroup on Physics of Life Processes until 1 September 2013, and the founding chair of the Platform Universitaire Natuurkunde.

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With funding from the provinces of Gelderland and Overijssel and the Twente region, the Center for Medical Imaging North East Netherlands (CMINEN) has established an Innovation Cluster in Twente where companies, researchers and users of medical imaging technologies can meet and strengthen one another. “By bringing all those involved into contact with one another at an early stage”, recount the passionate project leaders Jeanine de Regt and Elra Eppink, “you not only accelerate the processes, but the products that emerge are also better matched to the demand.” In response to six questions, de Regt and Eppink explain the ins and outs of this form of innovation.

CMI Twente Innovation Cluster: what does it entail? “As already stated, the aim of the Innovation Cluster is to accelerate innovation, i.e. to ensure that innovative products are made available to patients more quickly. In order to innovate in the field of health care, it is first of all important for entrepreneurs to know precisely what the clinical demand is. The Innovation Cluster forms the link between the clinical world, entrepreneur-ship and research. These parties are able to strengthen one another enormously”, according to de Regt. “Of course, this requires them to enter into dialogue with one another. This does not appear to happen very often. We aim to facilitate this interaction.” Eppink continues: “It is important in this respect that the Innovation Cluster is neutral and does not pursue any interests of its own, other than connecting parties, accelerating innovation and stimulating employment in the region. We work with a ‘hands on’ mentality and focus on building bridges.”

How do you facilitate this contact? De Regt: “We actively connect our members, some twenty companies and research institutions, to parties in a specific segment. We actively identify these matchmaking opportunities. Of course, it is also common for participants to submit a specific request to be connected to a party. We then, for example, arrange a company visit or a day of activities within a department.” “The placing of students from the Technical Medicine programme on assignments at

parties within the cluster is often also a catalyst for knowledge exchange,” continues Eppink. “Finally, by means of participation in our thematic meetings, encounters are also realised within specific domains. This, for example, takes place in thematic sessions on ultrasound and PET-MRI with the focus on dis-orders in the field of urology, cardiology, oncology and neurology, among others. We regularly organise these substantive sessions. The upcoming programme includes a second PET-MRI meeting, presentations in the field of Ultrasound, an anaes-thesia – long-distance care session, an MRI coils meeting and a PET-MRI symposium in cooperation with Siemens and Mallinckrodt .”

What does this interaction provide? “A result of the Innovation Cluster”, according to Eppink, “is that relatively small companies are able to use expertise and facilities that they could otherwise never afford. This means an enormous impulse for their production process. They are therefore able to grow and in this way create jobs for the region.” De Regt adds: “A second aspect is that, by bringing researchers into contact with demands from the market, they can integrate these into their research at an early stage. You are thus assured that innovations actually meet a need. Thirdly, this dialogue often produces new partnerships.” To illustrate: “Patients can greatly benefit if radiologists (MRI) and nuclear medicine practitioners (PET) colla-borate in the interpretation of medical images. The PET-MRI scanner we aim to install in Twente is a fine example of this multidisciplinary collaboration,” says de Regt.

How did the initiative come about? What was the source of inspiration?“The Innovation Cluster is affiliated with the CMINEN (with the University Medical Centre Groningen, Siemens and the University of Twente as founding partners). A few years ago, professor Peter Vooijs (at the time Medical Director of MIRA), together with the UMCG, Siemens and SMEs conceived a plan to form a partnership in line with the Technical Medicine programme (a new specialization), in which parties are represented that are closely related and that offer

MIRA

CMI TWENTE INNOVATION CLUSTER: COLLABORATION ACCELERATES INNOVATION!

Photo: Gijs van Ouwerkerk

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one another exceptional added value. Such parties are: clinicians, researchers and entrepreneurs”, according to Eppink. De Regt continues: “This ‘cross-border collaboration’ had previously never been seen. Based on this philosophy, the idea also emerged to substantiate this form of cooperation in Twente.”

Cross-border collaboration, was that also the driving force behind the recent Medical Tour to South Korea? “The main approach of the programme was indeed the intensification of the interaction between participants from universities, hospitals and the business community by feeding them with high-tech developments, and thus also to explore international opportunities for cooperation. In terms of content, the programme had a strong focus on the use of PET-MRI. For example, three South Korean University Medical Centres that perform research with PET-MRI were visited. One of these was a Neuroscience Research Institute. In addition, a visit was made to an IEEE conference that focuses on nuclear medicine and to medical and technical universities, hospitals and industrial players such as Siemens and Samsung Medison”, recounts de Regt.

Eppink continues: Particularly inspiring were the visits to Seoul National University Hospital (brand new facilities, including 3x 3T MRI, 3x 1.5T MRI, 1 x PET-MR, 4 x PET-CT, 4 CTs), the enormous potential of the use of robots in the health care that we saw at Postech University, and the largest private hospital in South Korea (funded by Samsung). This can right-fully be called the hospital of the future: they receive no less than 9,000 new patients every day and have 52 operating theatres. It was incredible: the patients enter via one of the six gates and are streamlined by means of the many IT applications.”

Finally: When is the Innovation Cluster successful? “The Innovation Cluster is successful if we help companies to grow, if we have been able to change the mindset to looking at the clinical demand (instead of reasoning on the basis of technological (im)possi-bilities) and if we have been able to realise acceleration in the innovations in the field of medical imaging during the process from research to marketing. If we have been able to achieve this, then our mission was successful”, conclude Eppink and De Regt.

QUOTES OF CMI MEMBERS

Dr. Riemer Slart, Nuclear Medicine Physician, UMCG “Medical imaging is recognized for being a fast-growing part of healthcare. Novel imaging techniques need to be developed and clinical applied, such as PET-MRI imaging. I am conscious about the indications for PET-MRI imaging, the expected volume of procedures and the diffusion of advanced imaging equipment. It is likely this will improve patient outcomes, reduce costs for medical imaging.  CMI bridges the unique benefits of technologically driven development of imaging techniques at University of Twente  supported by industry, into medical applications in the affiliated academical centers in Groningen and Nijmegen.”

Dr. Eric P. Visser, head of medical physics and ICT, Nuclear Medicine, Radboud UMC:“My first acquaintance with Technical Medicine in Twente was during the spring of 2008 with the coming of the first students to the department of Nuclear Medicine of the Radboud UMC for their internships. It was surprising how well these students were educated in both medical and technical subjects. Many scientific papers have resulted from these internships, as well as a PhD thesis (2011). Two PhD students are currently working on their theses in our depart-ment. Finally, a “TG-fellowship” was organized to exploit the synergy in multi-modality imaging and radiation therapy in a joint project of the Radiology, Nuclear Medicine and Radia-tion Therapy departments of Radboud UMC. It was inspiring to see the maturation of Technical Medicine in the course of the recent years. The same holds to my opinion for the Centre for Medical Imaging. CMI has now reached critical mass and momentum in bringing together medically, technically, and business oriented persons sharing their enthusiasm and their ideas. Personally, I see the strong added value of a state of the art PET-MRI scanner located in Twente by bringing together the “engineers” who could for instance test and improve issues such as advanced image reconstruction algorithms, technology for patient motion registration and development of  the corresponding correction algorithms, new detector technology, etc. and the “medical doctors” who can perform their patient oriented research in which the added value of perfectly co-registered and simultaneously recorded PET and MRI images is crucial. Next to this, the business case of this PET-MRI scanner can be supported by referring patients who otherwise would have underwent two separate scans to this combined scanner, thus saving time and money.”     

Ir. Ivo Aarninkhof, Partner Holland Innovative “The field of innovations in medical devices and products requires a close loop between the customer insights & their insights and the academic or innovators world. Bringing together these needs via a structured process requires experience as well as a structured methodology like our company is doing. I have experienced the Centre of Medical Imaging leadership team of the University of Twente extremely well connected in both worlds. Their efforts and constructive attitude has helped to bridge connections as well as supporting setting up new ventures. For us a company this has been proven to be extremely powerful.”

Prof. dr. ir. Stefano Stramigioli, Chairman of the groupRobotics and Mechatronics, University of Twente“Once again the CMI trip was a great success: during the visit to South-Korea we had the opportunity to extend the CMI network, to get inspiration from the many hosts we visited and we also had the opportunity to internally develop new contacts and ideas. The CMI Innovation Cluster is able to create synergies toward the development of new clinically relevant ideas.”

Photo: Gijs van Ouwerkerk

Our visiting address

University of Twente

MIRA

Building Zuidhorst I Drienerlolaan 5

7522 NB Enschede I The Netherlands

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University of Twente

MIRA

P.O. Box 217 I 7522 NB Enschede

The Netherlands

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