when medical interventions are revolutionised by …...global market for robotic surgical devices...

WHEN MEDICAL INTERVENTIONS ARE REVOLUTIONISED BY THE TRANSITION TO DIGITAL !

June 2019

Document created in partnership with

THEMATIC DOSSIER

2 - CAMI thematic dossier

EDIT RIAL

Anne PoteyConsulting Engineer

In Extenso Innovation [email protected]

Tél : +33 (0)4 37 23 12 70

Myriam RahalMarketing Executive

SATT Ouest [email protected]

Tél : +33 (0)2 99 87 46 51

What if the surgeon were to prepare his operation like a pilot simulating his flight … These days there are more than 4000 Da

Vinci surgical robots installed worldwide (123 in France). They have enabled surgeons to perform more than 5 million minimally invasive operations. This confirms that radiology and computer assisted surgery are making it possible to improve the quality of medical and surgical procedures and represent the future of medicine.

CAMI, or Computer Assisted Medical Interventions, bring together a set of computer tools and methodologies intended to assist health professionals in the preparation and performance of an operation or other medical procedures. The CAMI field includes a very large number of technologies such as software for simulation, planning and training for operations, navigational aids, augmented reality devices, surgical robots and many others.

The digital revolution has opened the possibilities of dynamising operating theatres and, more generally, medical practice, the precision of the procedure and control of the performance of the intervention, which is more than ever at the heart of health professionals’ considerations. Innovative technologies which enable medical errors to be reduced meet a strong societal and medical expectation.

In accordance with market requirements, SATT Ouest Valorisation selects and supports many ambitious projects, which will be involved in the development of technologies within the fields of radiology and computer assisted surgery. It is therefore with immense pleasure that we present this thematic dossier to you. It is a narrative that will enable you to identify the challenges in these technologies of the future.

Happy reading !

Bruno Westeel Marketing & Communications Manager

SATT Ouest Valorisation


C NTENTS

Contributors :

Arnaud TrochetMapping/Monitoring Engineer

SATT Ouest Valorisation [email protected]

Tél : +33 (0)2 99 87 56 23

Anne PoteyConsulting Engineer


Tél : +33 (0)4 37 23 12 70

David AfriatPartner


Tél : +33 (0)6 50 21 19 25

CONTENTS

#1 Infographics Page 4

#2

#3

Interview with Pierre Jannin Page 6

The Market by In Extenso

Page 8

Patent mappingPage 14

The technology offers from SATT Ouest Valorisation

Page 16

The platformsPage 22

The creation of start-ups supported by SATT

Page 25

The European Digi-NewB projectPage 26

The RHU FollowKneePage 28

The Labcom LITISPage 29

SATT Ouest Valorisation 0

Your contactsPage 32

#4

#5

#6

#7

#8

#9

#12

#10

#11

Myriam RahalMarketing Executive

SATT Ouest [email protected]

Tél : +33 (0)2 99 87 46 51


56% of the market in North America

INFOGRAPHICS

INFOGRAPHICS

Surgical robots

CAMI

TPS Market(M. $)

Pre- and per-operative computer tools

Training and practice interfaces for health

professionals

PATIENT

SCREENS

SOFTWARE DATAANATOMY

Software and medical simulation devices

market (Mds $)

Global market for robotic surgical devices (Mds $)

3% Neurology

4% Others

30% General Surgery

31% Gynecology

14% Urology

13% Orthopedics

5% Interventional

Cardiology

4% Others 57%

Varian

25% Elekta

8% Siemens

6% Accuaray

2017 2023

Computer Assisted Medical Interventions

+ 12,4% / year

1,08

2,19

2017 2025

+ 12% / year

5,07

12,6

2017 2022

+ 8,2% / year

470645

Reduction in medical errors as a result a more precise, more effective procedure

Less invasive surgical procedures

Time saving in decision making

New training methods for health professionals

Distribution of the TPS market by players


INFOGRAPHICS

LaTIM

Medical Information Processing Laboratory (UMR 1101 – Director: Eric Stindel)

68 Collaboration Agreements managed by SATT including :

5 Patents currently managed by SATT 10 Software filed by SATT since 20125 CIFRE agreements1 Framework Cooperation Agreement9 Consortium agreement6 Collaboration agreement with companies

LTSI Signal and Image Processing Laboratory

(UMR 1099 - Director: Lotfi Senhadji)

230 Collaboration SATT including :

25 patents currently under management47 Software copyrighted by SATT since 201216 CIFRE contracts6 Framework Cooperation Agreement36 Consortium agreements26 Collaboration agreements with companies

NAVIGATION

SURGERY

MEDICAL

ARTIFICIAL INTELLIGENCE

PATIENT

INSTRUMENTS

MONITORING

SCREENS

RADIOTHERAPY

SOFTWARE DATA

PRECISIONPREDICTIVE

DIAGNOSTICS

INFORMATION TECHNOLOGY

DIGITALRADIOLOGY

IMAGE

MODELSROBOTICSPLANNING

ANATOMY

CAMI

57% Varian

+ +Computer Assisted Medical Interventions

Reduction in medical errors as a result a more precise, more effective procedure

Less invasive surgical procedures

Time saving in decision making

New training methods for health professionals


INTERVIEW WITH PIERRE JANNIN


1 CAS : Computer Assisted Surgery

WHAT ARE YOUR THOUGHTS

ABOUT THE DEVELOPMENTS

IN RADIOLOGY AND CAS1 DURING

THE LAST FEW YEARS ?

In recent years radiology and surgery have

benefited from the introduction of digital and

information technologies.

These technologies have made it possible to

increase precision and quality both for diagnostics

and surgical treatment.

The technology also enables errors to be reduced

and allows the use of less invasive surgical

procedures. Nevertheless, it is important to stress

that the introduction of this technology has, at

the same time, led to an increase in pressure on

professionals. They are required not only to work

better but faster and faster. This is clearly a point

on which everyone must concentrate their efforts

so that the medicine of the future is of high quality.

WHAT IS YOUR PERCEPTION

OF THE FUTURE FOR

RADIOLOGY AND SURGERY ?

Medicine in the future is going to become ever

more rational, more predictive, more preventive

and more personalised. Technology will not only

be an aid for performance, but also for learning

and improvement. To do this what we now call

artificial intelligence, or principally data science

from automatic learning methods, will become a

key element.



WHAT ROLE DOES SATT

PLAY AND HAS IT PLAYED IN

SUPPORTING YOUR TEAMS AND

IN THE DEVELOPMENT OF YOUR

TECHNOLOGIES IN THESE FIELDS ?

Today SATT has a determinant role in my research

projects, which has been expected for a long

time. SATT provides me with significant support in

facilitating the transfer of the research to industry.

This includes the management of intellectual

property, market research, assistance with

technological maturation to increase the TRL2

and the management of contractual relationships

with industry. Over time we have also succeeded

in building long-term relationships of trust which

are enabling us to build the medicine of tomorrow

together.

2TRL : Technology Readiness Level

Pierre Jannin,Research Director at l’INSERM - MEDICIS,

LTSI Team (UMR 1099)

Chairman of CARS 2019


THE MARKET

Improving the quality of medical interventions is a constant aim in medicine. The advent of minimally invasive surgery has made the invasiveness of operations as low as possible. Moreover, computer tools have been developed to guarantee medical procedures that are ever more precise and effective.

CAMI, or Computer Assisted Medical Interventions, bring together a set of computer tools and methodologies intended to assist health professionals in the preparation and performance of an operation or other medical procedures. It was quickly proved that CAMI would not be limited just to image analysis.

These technologies involve an inter-disciplinary approach to make it possible to capture the relevant information (pre-, per- and post-operative), to merge all this information into models allowing the operation to be simulated and planned in an optimum manner. This then enables the surgeon to carry out the operation using “surgical navigation” systems or medical robots.

According to UJF (Joseph Fourier University, Grenoble) Professor Philippe Cinquin, the combination of three forces, science, medicine and industry, is key to the success of CAMI3.

The first applications proved to be very specific, for example inserting a screw into a vertebra in

the right axis or obtaining perfect alignment in the positioning of a knee prosthesis. They later became more generalised. In fact, since then neurosurgery, urology, radiotherapy, interventional radiology and many other applications have all benefited.

The field of computer assisted medical interventions includes a vast number of technologies: software for simulating, planning and practising operations, aids for navigation in the operating area, augmented reality devices, surgical robots, remote surgery, etc.4

These technologies may be separated into 3 categories :

THE CAMI MARKET

3 CAMI : Computer Assisted Medical Interventions, 2012 : https://bit.ly/2wBqONS4 Inserm, “ Chirurgie assistée par ordinateur (CAO) [Computer Assisted Surgery (CAS)]- L’informatique révolutionne le bloc opératoire [Computers are revolutionising the operating theatre] ”, 2016 : https://bit.ly/2HTZa5a

Augmentedperception

Augmenteddecision

Augmentedlearning

Augmentedaction

Pre- and per-operative computer tools

Surgical robots

Training and practice interface for health professionals

ADDED VALUE OF CAMI TECHNOLOGIES FOR HEALTH PROFESSIONALS

A

B

C

What’s more, surgeons and other medical professionals can also use CAMI tools for training and practice. The solutions offered are ever more sophisticated and offer 3D virtual reality interfaces that allow the simulation of an upcoming operation or facilitate the learning of a new surgical procedure.

Pre-operative

Pre-operative

Per-operative /

post-operative


THE MARKET

MAIN TRENDS IN THE CAMI FIELD

CAMI is built around a logic in 3 large stages :

What’s more, surgeons and other medical professionals can also use CAMI tools for training and practice. The solutions offered are ever more sophisticated and offer 3D virtual reality interfaces that allow the simulation of an upcoming operation or facilitate the learning of a new surgical procedure.

As well as the dynamism of the research and development in big companies such as Medtronic, Philips Healthcare and Siemens AG, academic laboratories in the field are very active. In France, the Labex CAMI laboratory has 6 French research units specialising in and developing Man-Machine interfaces for laparoscopy, and even simulation models of tissue/device interaction for endovascular device implantation. These initiatives encourage multi-disciplinary teams of researchers, engineers and doctors to meet.

CAMI is a fast-growing sector, the dynamism of which is revolutionising operating theatres and more generally medical practice. CAMI technologies have high growth markets undergoing constant development.

Data collection (traditional and new medical imaging, computer vision, metrology using sensors): the aim is to gather detailed information about anatomical areas of interest. It is then possible to build a virtual model of the patient (anatomical models, statistical models, etc.).

Key technologies : MRI, CT scan, X-ray, etc.), sensor system (electromagnetic, electrographic)

Planning of the medical or surgical intervention. To do this the surgeon will use the virtual model of the patient to define the best operating strategy.Key technologies : optimisation tools such as software for radiotherapy planning (TPS), simulation software, anatomical models, geometric and/or mechanical modelling tools (e.g. for difficult approaches with complex trajectories, or in situations in which the anatomical structures being operated upon may move, or even deform, during the course of the operation), and so on.

Pre-operative

Pre-operative

Per-operative /

post-operative

Transfer of data from the planning performed on the model of the patient to the conditions in the operating theatre. The information may be transferred on control screens used by the surgeon, or for programming the surgical robots: anatomical landmarks, targets to be reached, borders between the various structures/tissues.Key technologies: surgical robots, surgical navigation system (resetting and advanced display) real time monitoring system, etc.


THE MARKET

SURGICAL ROBOTSAmongst the technologies involved in CAMI, surgical robots are technological solutions with high potential. They make it possible to improve the precision of the procedure and give better control over the performance of the intervention.

The surgical robots market was estimated to be in the region of 5.07 billion dollars in 2017 and should reach more than 12.6 billion dollars by 2025, with an AAGR5 of 12% between 2017 and 2025. This market is experiencing very significant growth, particularly due to the emergence of day surgery and minimally invasive surgery6.

There were 4149 Da Vinci systems installed worldwide in 2017. Da Vinci robots are marketed by Intuitive Surgical which had a 67% market share for robotic surgical devices in 2016. There is great disparity between countries given :

• The high price of surgical robots. For example, a Da Vinci robot costs about one million Euros.• Health systems differ and the invoicing of a procedure varies from one country to another.• The need for in-depth training of surgeons in the use of these robots.

Robot Da Vinci (Intuitive surgical)

Many governments have started aid initiatives to assist public institutions with their financing difficulties. In 2013, the US Government launched “The National Robotics Initiative” and provided aid for the development of new systems. In 2016, the UK Government launched a 526 million dollar fund for the development of new surgical robotic systems.

SEGMENTATION BY PRODUCT TYPE, APPLICATION AND GEOGRAPHICAL AREA FOR THE SURGICAL ROBOTS MARKET

5AAGR: Average Annual Growth Rate6Global surgical robotics market – 2017-2025, BIS Research

Global market for robotic surgical devices (billions of dollars) - Source : In Extenso

Source : In Extenso Innovation Croissance

Distribution of the global market by product types in 2016

Distribution of the market by application in 2016

Geographical distribution of the global market in 2016

Services(maintenance,

etc.)24%

Roboticsystem

27%

Instruments andaccessories

49%

Interventional Cardiology5%

Neurology3% Other

4%

General surgery

30%

Gynaecology31%

Orthopaedics13%

Urology14% North America

56%

Asia Pacific17%

Europe19%

Latin America3%

Rest of the world5%


THE MARKET

The market for software and medical simulation devices (learning and training for professionals) was estimated to be 1.08 billion dollars in 2017 and should reach 2.19 billion dollars in 2023, with a CAGR of 12.4%. Software and services take up 34% of the market and 66% for the devices (hardware)7.

Simulation of the specific virtual reality of the patient (virtual “clone”) is a technological advance which allows operations to be practised, and therefore the surgical procedures can be anticipated.

These innovations drive medical simulation. There are also consultation simulation software and devices to simulate ultrasound, endoscopic and laparoscopic examinations, etc. These technologies enable students and health professionals to face, in a risk-free manner, situations where their composure and ability to make decisions are assessed in emergency situations8.

The planning software market is segmented according to medical specialities.

The TPS (Treatment Planning System), or radiotherapy planning software, segment is one of the most dynamic in the market for software used in oncology, with an estimated annual growth of 8.2% to reach 645 million dollars in 2022. 88% of the market is dominated by 3 main manufacturers: Varian, Elekta and Accuray9.

Robot Da Vinci (Intuitive surgical)

Many governments have started aid initiatives to assist public institutions with their financing difficulties. In 2013, the US Government launched “The National Robotics Initiative” and provided aid for the development of new systems. In 2016, the UK Government launched a 526 million dollar fund for the development of new surgical robotic systems.

There are 3 sub-segments in the surgical robots market: services, robotic systems and instruments and accessories. The instruments and accessories market is 49% of the total market because it includes consumables and

7 Global Medical simulation market 2017-2023 – Mordor Intelligence8 https://www.medicactiv.com/fr/consulter-un-cas/9 Global oncology information systems market, 2014-2022, Allied Market Research10 Global medical imaging software market, 2017-2021, Technavio

Furthermore, the image analysis software market should reach 3.6 billion dollars in 2017 and 4.4 billion dollars in 2020. Between 2016 and 2021 the estimated CAGR is 6.8%10.

As a result of surgical robots, planning software and other CAMI technologies, the improvement in surgeons’ performance is significant in terms of increased precision, time savings, increased reliability, reduction in invasive nature, etc.

parts, which have a higher renewal rate than the system itself. In fact, for a Da Vinci robot about €150 in consumables per operation should be expected.

TRAINING AND PRACTICE INTERFACES FOR HEALTH PROFESSIONALS

PRE- AND PER-OPERATIVE COMPUTER TOOLS

Distribution of the TPS market by playersDevelopment of the world TPS market (in millions of $)

Source : In Extenso Innovation Croissance

Geographical distribution of the global market in 2016

North America56%


THE MARKET

THE SOCIAL AND ECONOMIC IMPACT OF CAMI TECHNOLOGIES : REDUCTION IN MEDICAL ERRORS

A study conducted in 2018 by John Hopkins University (Maryland) estimated there were about 250,000 deaths linked to medical error in the United States. Other studies have gone as far as to estimate the number of deaths to be 440,000 people11.

A medical error may go unseen during the operation with the use of conventional imaging machines, and the technical error only appears in post-operative monitoring. The advantage of the new CAMI technologies is faster (or even immediate) detection of faults which, without these technologies, would only have been

TIME-TO-MARKET AND IDENTIFIED OBSTACLES TO THE ADOPTION OF THESE NEW TECHNOLOGIES

CAMI research is a field which has many technical challenges, from the design of new sensors to their calibration, from the segmentation of images to matching them, as well as the development of advanced algorithms enabling combined data analysis.

11 Ray Sipherd, “The third leading cause of death in US most doctors don’t want you to know about”, 2018 : https://cnb.cx/2F6c1Rj12 and 13 Victor Dubois-Ferrière & Mathieu Assal, “Bénéfice de la chirurgie assistée par ordinateur en orthopédie : application au domaine du pied et de la cheville [Benefit of Computer Assisted Surgery in orthopaedics : application to the foot and ankle]”, 2014 : https://bit.ly/2XoiyMM14 https://www.ltsi.univ-rennes1.fr/THERA-IMAGE15 Aurélie Sobocinski, “ Prix de l’inventeur européen : Philippe Cinquin en finale ! {European inventor prize : Philippe Cinquin in the final !] “, 2014 : https://bit.ly/2MB3w5I

The image and signal processing laboratory (LTSI) of the University of Rennes has set up the TherA-Image platform: an operating theatre making it possible to develop and test various devices in real conditions.14 This theatre is both a place of treatment and of research enabling doctors, engineers and researchers to collaborate on projects that are basically devoted to the cardiovascular field.

Furthermore, today’s challenge is to be able to make CAMI technologies more accessible with solutions that can be easily installed in health establishments, and which are also financially accessible. Whether for planning software or surgical robots, investment in this type of tool remains significant for health establishments. The risk of CAMI is the possibility of two-speed medicine appearing: centres of excellence able to acquire these devices (via public financing and self-financing) and establishments that are more on the margins and incapable of financing these devices (rural environment, less specialised establishments, developing countries, etc.)15.

Medical teams are therefore waiting for substantial scientific proof of efficacy, medical and economic impact, and added value compared with current tools and standard surgery. Justifying such an investment and total integration of these new technologies in the future both require this medical validation.

detected during the medical follow-up. The surgeon can, therefore, correct the problem during the same operating session and avoid secondary revision surgery12.

A study dating back to 2009, performed on 248 patients, showed that carrying out 3D intra-operative imaging made it possible to detect 19% of fractures that were not reduced, or incorrect positioning of implants that required correction13.


THE MARKET

What’s next ?BIOCHEMICALMODELLING OF SOFT TISSUE IN THE HUMAN BODY

Mathematical models and the associated software allow increasingly specific prediction of organ/tissue/bone deformation following external and internal constraints. These models provide ever greater precision, particularly making it possible to estimate the mechanical and functional consequences of an operation (e.g. tibial osteotomy) and thus make the best choice of treatment strategy and suitable medical follow-up for the patient16.

In coming years we should see the advent of mathematical models specific to each patient enabling personalised anatomical models to be created to achieve even greater efficacy.

REAL TIME IMPROVEMENT : PER-OPERATIVE

Many innovations are seeing the light of day in the field of real time aid for surgeons during an operation : neuronavigation, detection of tissues of interest, etc. All these solutions help to improve the patient pathway in terms of performance, precision and post-operative follow-up quality.In this field the fluorescence imaging system, FLUOBEAM®, enables the parathyroid glands to be detected by autofluorescence in real time during surgical procedures such as thyroidectomy (total or partial ablation of the thyroid) and parathyroidectomy (total or partial ablation of the parathyroids)17.

SMALLER AND SMALLER ROBOTS

Another underlying trend to come : the miniaturisation of robots so that they can be installed more easily in healthcare establishments and thus reduce a barrier to the adoption of these new technologies. This is the case for the Versius Robot, developed by British researchers and the manufacturer, Cambridge Medical Robotics. This robot enables operations to be performed in areas of the human body that are very narrow (ears, nose, throat), whilst being easily transportable (an answer to the problem of lack of space in hospitals).

16 Yohan Payan, “Biomécanique pour les gestes médico-chirurgicaux assistés par ordinateur [Biomechanics for Computer Assisted Medical Interventions]”, 2014 : https://bit.ly/2Idm0n517 Medicalps, “FLUOPTICS obtient la certification FDA pour la mise sur le marché américain du FLUOBEAM® pour la détection des parathyroïdes en temps réel pendant la chirurgie [FLUOPTICS obtains FDA certification for placing FLUOBEAM® on the American market for the detection of the parathyroids in real time during surgery]”, 2018 : https://bit.ly/2wAbHUK

Versius Robot

In the years to come, computers will become ever more important during medical procedures and also pre- and post-operatively. Some people wonder where these innovations are going and what place the practitioner will have in the face of these new technologies.In the coming years the place of data must continue to grow. However, the clinical and economic benefits of these innovations should be proved before long-term integration into the medical landscape.


PATENT MAPPING

Technologies related to computer assisted surgery and/or robotic surgery are now a reality, and innovation in the field is booming. In fact, the number of patent applications published has continued to increase in the last five years. Patent mapping has been conducted by SATT Ouest Valorisation to gain an insight into the innovation dynamics and to identify ‘key’ players in the field, both worldwide and in France.

The graph below depicts the evolution in time of the publications for priority filing of patent applications/patents worldwide since 2000. These specifically claim technologies related to computer assisted surgery and/or robotic surgery.

There have been considerable developments in innovation associated with these technologies over the course of the last two decades, with an extremely significant increase in patent filing over the last few years. In fact, a total of nearly 17,000 published patent families have been identified, of which 54% were between 2013 and 2018 with an Average Annual Growth Rate (AAGR) of +18% over the same period.

This growth illustrates a patent race and attests to the sustained pace for this, and the desire of stakeholders to retain their competitive advantage by protecting their inventions.

EVOLUTION OF PATENT FAMILIES OVER TIMEWORLDWIDE

Computer assisted surgery and robotic surgery

PATENT MAPPING TECHNOLOGIES RELATED TO COMPUTER ASSISTED SURGERY AND ROBOTIC SURGERY

The year of publication equates to the year in which the first patent family application was published.A patent family can be defined as a set of patents (priority patents + extensions) filed in various countries to protect the same invention.

Source : SATT Ouest Valorisation (Questel-ORBIT tool)

Num

ber

of p

aten

t fa

mili

es

Nearly 17

,000

patent familie

s

First year of publication


PATENT MAPPING

Research and development activities in terms of the number of patent families are mainly located in the United States. In fact, the United States is a world leader for patent filing covering 53% of priority filings for the subject studied over the last 20 years, followed by China with 22% of filings and Germany (7%). France comes in ninth position with 220 published FR priority filings, representing 1.3% of filings worldwide.

The countries for protection of inventions in force are mainly located in the United States (45% of filings),

in China (33%), via the European procedure-EP (31%), in Japan (18%), in Germany (15%) and in the United Kingdom (11%). This indicates that these countries kindle an interest, especially commercial, for the many applicants. In fact, the targeted countries for protection reflect the territories where the markets are located and where holders therefore hope to obtain a competitive advantage (manufacturing, production, importation and marketing).

Source : SATT Ouest Valorisation (Questel tool)

CLASSIFICATION OF THE MAIN WORLDWIDE AND “FRENCH” APPLICANTSComputer assisted surgery and robotic surgery

On the subject worldwide, INTUITIVE SURGICAL is the driver for patent filing with 755 patent families followed by COVIDIEN (454 families), OLYMPUS (323 families), ETHICON (311 families), PHILIPS (278 families) and BRAINLAB (263 families).

Amongst the top “French” applicants (on the basis of FR priority filings, i.e. 220 patent families) having at least 3 patent families in the field :

• 17 are industrial applicants (GE, ROBOCATH, MEDTECH, TORNIER, DEXTERITE SURGICAL, OMNILIFE SCIENCE etc.).

• 12 are academic applicants (CNRS, GRENOBLE ALPES UNIVERSITY, UNIVERSITY OF STRASBOURG, CEA, INSERM, INRIA, INSA, UNIVERSITY OF WESTERN BRITTANY, UNIVERSITY OF RENNES 1 etc.).

Want to know more? The complete, detailed study of patent mapping is available here : https://bit.ly/2wsQsnL

Number of patent families Number of patent families

Other : academic etc.

Industrial

Industrial

Other: academic etc.

755 Patent families

454 Patent families

323 Patent families

311 Patent families

278 Patent families

263 Patent families

18 Patent families

15 Patent families

11 Patent families

11 Patent families

9 Patent families

6 Patent families

TOP 6 French applicantsTOP 6 global applicants


TECHNOLOGY OFFERS FROM SATT OUEST VALORISATION

PyDBS Image-guided Deep Brain StimulationDeep brain stimulation (DBS) is a surgical technique developed at the end of the 1980s by the French neurosurgeon and physician, Alim-Louis Benabid. Since then it has proved to be effective for neurodegenerative diseases, particularly for Parkinson’s Disease. Worldwide more than 100,000 patients have now benefited from a DBS procedure. This treatment method improves both symptoms and quality of life considerably (see Earlystim study conducted on more than 250 patients).

Whilst it is now recognised that DBS could benefit a large number of neurological disorders (e.g. Parkinson’s, epilepsy, dystonia, etc.), the prevalence and incidence of which are increasing, it is now necessary to simplify and make this complex surgical procedure as safe as possible so that it can be more widely deployed, and so that neurosurgeon training is optimised.

So the current challenge of DBS lies in constant improvement of the environment for the surgical procedure to allow faster, more precise planning to ensure safer, more effective implantation (assistance in the surgical procedure), for example by improving the level of initial accuracy in locating the target.

THE INNOVATIVE OFFER

The PyDBS project involves developing a complete image guided and assisted environment for the DBS procedure. The procedure involves implanting two electrical stimulation electrodes deep into the brain, to target precise anatomical areas which will react to the electrical stimulation applied.

This project’s purpose is to deploy a complete software platform to assist and guide the neurosurgeon by imaging, involving the use of the following techniques: - 3D multimodal medical imaging - fusion and deformation of medical images - 3D modelling and - statistical analysis.

This platform will make it possible to optimise the various phases of the procedure such as:- planning: personalisation taking into account the desired clinical scores - the choice of implantation trajectory and anatomical target: improvement in precision due to the new more efficient anatomical and anatamo-clinical atlases, and the use of resetting and fusion methods at the forefront of technology- the simulation of the therapeutic and side effects of electrical stimulation: simulation module taking existing clinical results into account- post-operative analysis of the effect of the implanted trajectory on the clinical results: constant improvement of future surgeries due to the construction of anatamo-clinical atlases.

TECHNOLOGY OFFERSFROM SATT OUEST VALORISATIONAs you have seen throughout this document, the CAMI field is more than ever seeking to win the battle for increasingly high performance, intelligent innovations. This sector’s environmental and social challenges are very high and require continuous research in terms of innovation.SATT Ouest Valorisation is investing in the detection, protection and maturing of projects which can respond to market requirements. Here are some of the technologies to be found in its CAMI portfolio.



FURTHER INFORMATION

APPLICATION

The innovation is software for Deep Brain Stimulation (DBS) procedures

Targeted diseases: neurodegenerative diseases such as Parkinson’s Disease (priority treatment target for the project today) and other neurological disorders that could be treated by DBS.

BENEFITS

Semi-quantitative and qualitative study in progress (Jan 2018 – Jul. 2019)

Preliminary results:

Benefits for the neurosurgeon: Increased precision in the procedure (optimisation of all the trajectories for implanting the electrodes), increased confidence in the efficacy of the procedure and time savings (reduction in operating time)

Clinical benefits: Operating time reduced providing a decrease in infection risks and improvement in patient comfort (awake during the procedure); Personalised planning taking account of the patient’s wishes (which clinical score should be improved as a priority)

ASSOCIATED INTELLECTUAL PROPERTY :

LABORATORIES : LTSI (Signal and Image Processing Laboratory)

Stage of development

The software is installed and used at the CHU de Rennes (Rennes University Hospital) for research purposes.

Clinical validation.

Title

“Method for simulating brain stimulation, corresponding computer program and device”

“Proficiency Assessment System and method for deep brain stimulation (DBS)”

“PyDBS”

“REF-MEDATLIS”“BRAIN PILOT”

“PARK-MEDATLIS”

Prio : FR 14 58310Extensions :US : US2017286629EP : EP3189454JP : JP201753299CN : CN106687962HK : HK17113982

Prio : EP 17306370PCT :

PCT/EP2018/077446

09/04/2014

10/05/201707/12/201711/09/201705/17/201712/29/2017

10/11/201710/09/2018

10/07/2015 to the APP

07/01/2015 to the APP

03/21/2016 to the APP

03/29/2016 to the APP

Delivered

Delivered In progress

DeliveredDeliveredDeliveredDelivered

Patents

Software

Database

File number Filing date State



S3PM : Immersive operating theatre training simulation system

The innovation is an immersive training system for the procedural and non-technical skills which takes place in a virtual operating theatre. It consists of the following elements :

A scenario editor An immersive virtual simulator An evaluation tool using metrics to evaluate

performance

The training system is produced from the acquisition of procedural and evaluation knowledge. It has the following characteristics :

Scenarios are generated from observations The system is based on surgical process modelling

(SPM) The focus of the application is neurosurgical nurses

so that the right instrument is given at the right time Access to rare and realistic surgical scenarios

The training system includes an operating theatre for simulating errors, and training in awareness of the situation in terms of hygiene and safety. The system also allows training in non-technical skills :

Training to develop awareness Training for making diagnoses and preventing

errors Training for preparing the treatment decision


BENEFITS

Training in a controlled environment

Reduces training costs

Repeatability of sessions and reuse of scenarios

Evaluation using qualitative and quantitative data

Awareness of behavioural skills

Training in stress management

Training for making diagnoses and preventing errors

Preparing a treatment decision

Collaborating in a virtual environment (scenario can be played by an avatar)


FURTHER INFORMATION

LABORATORY :MEDICIS - UMR_S 1099 - LTSI

ASSOCIATED INTELLECTUAL PROPERTY : Priority filing - FR1461848 filed on 03/12/2014WO-CN, EP, US

APPLICATIONS

Training and evaluation of behavioural skills in a controlled virtual environment

Training of health professionals

Stage of development

TRL6 - Demonstration of the prototype.



The innovation is defined as a patient surface imaging system for radiotherapy applications and is based on ToF (Time of Flight) technology. This medical device is the first non-irradiating system enabling predictive models of internal structures to be reconstituted from the patient’s surface movements.

This system provides several integrated functions: repositioning of the patient during the inter-fraction period, monitoring of voluntary or involuntary movements of patients during the intra-fraction period which have a direct incidence on the dose delivered, and therefore improving the patient’s safety in terms of side effects and collision risk.

The device also provides a correlation of the surface imaging of the patient with the movement of the internal structures (e.g. respiratory movements) and patient identification, thus meeting the requirements for identity monitoring. The innovation makes it possible to optimise the radiation dose delivered to the tumour whilst sparing the healthy peripheral tissues and the at-risk organs. This is a major expectation for radiotherapy.

SDSP: Dynamic Patient Surface Monitoring system in radiotherapy



BENEFITS

Unique machine for monitoring the patient’s movements (intra- and inter-fraction) and his/her identification

Obtaining predictive models of the internal structures: dose optimisation

No irradiation: no toxicity

Compatible with MRI-guided radiotherapy systems

Complete imaging of the patient’s surface in real time

Ergonomic device taking up little space

Competitive price

APPLICATIONS

External radiotherapy

FURTHER INFORMATIONStage of development

TRL6 - Demonstration of the prototype adapted for clinical research

Clinical investigation: Clinical evaluation

- For repositioning: validation study conducted on 150 fractions

- For modelling internal structures: 5 patients

- For respiratory monitoring : 10 patients

«SATT has provided us the necessary means to achieve the pre-industrialization of our research project […] the developments make it possible to generalize the use of our technology and, consequently, to facilitate the realization of clinical studies at larger scale in targeted areas of application (radiotherapy, intensive care) ».

Dimitris VISVIKIS Research Director at INSERM Operationnal Director at LaTIM in ACTION (Therapy Action using multimodality Imaging in ONcology)

RESEARCH UNIT :IPAL Team - Physiological Information for the Musculoskeletal SystemLATIM - LAboratoire de Traitement de l’Information Médicale - UMR_S 1101

INTELLECTUAL PROPERTY : Priority filing IDDN.FR.001.190002.000.S.P.2017.000.10000 on 02/05/2017


TECHNOLOGY PLATFORMS


TherA-Image Platform for therapy assisted by imaging technologies

TherA-Image is a hybrid operating theatre, a place for both treatment and research in the field of health technologies.

This is a medical and technical platform located at the interface between the Rennes University Hospital, University of Rennes 1, Inserm and the medical industry.

On this platform computerised approaches to planning operations, assistance with operating procedures and their evaluation are designed and deployed.

Unique in Europe, the combination of this equipment and these skills within a single operating theatre in Rennes results in a meeting of minds built over a long period within the LTSI multi-disciplinary teams, incorporating doctors, researchers and engineers. It also results in a solid partnership to be maintained over time with industrialists which are leaders in their field.

Platforms are structures which make the equipment and skills of higher education establishments available. In this way, companies can access excellent material and high added value human skills, or a turnkey service. These platforms enable the resources of universities to be pooled with those of companies.

TherA-Image is the instrument of a profound development in medical research and in the associated business cultures. It paves the way for the design, deployment and evaluation of tomorrow’s operating procedures for the patient’s benefit.

TherA-Image was inaugurated in 2013 and was financed within the framework of the 2007-2013 State-Region project contract. It received support from the European Union, the French Government, the Brittany Region and the General Council of Ille-et-Vilaine and Rennes Métropole.

Laboratory: LTSI

Associated establishments : Rennes University Hospital, University of Rennes 1, Inserm

SATT Ouest Valorisation offers innovative resources from over 60 platforms. Its aim is to grow the platforms’ service offer by professionalising the commercial roll-out.

Here are platforms that are expert in the CAMI field and their service offers.



TerA-techResearch and development platform for therapies by implantable medical devices

TherA-Image is a hybrid operating theatre, a place for both treatment and research in the field of health technologies.

TerA-tech is a new experimentation platform at the Rennes University Hospital which, in 2019, will enable experiments in new advanced operating techniques, particularly implantable devices, to be carried out on animals. A 5.5 million Euro investment has been necessary to construct it, financed within the framework of a State-Region plan together with Inserm and the Medical School. This platform will have a 500 m2 surface, including 300 m2 for experimentation and 200 m2 for logistics. It should become a valuable asset for the University Hospital.

Continuous with the TherA-Image platform, this new platform will be an additional asset for the University Hospital and is expected to be operational in 2019. In fact, as well as preclinical experiments, it will offer other prospects for research and training and could facilitate new partnerships, open to French or foreign industry. (Source : Interview with Philippe Mabo, Head of the Cardiology and Vascular Disease Department at the Rennes University Hospital).

Laboratory : INRIAAssociated establishments : University of Rennes 1,

CNRS, Rennes University Hospitals

Laboratory: LTSI

Associated establishments : Rennes University Hospital, University of Rennes 1, Inserm

NeurinfoImaging and Neuroinformatics Platform

Neurinfo is a technical platform offering imaging resources for the development and enhancement of clinical, methodological and technological research activities. This platform concerns in vivo human imaging and neuroinformatics, especially in the context of diseases of the nervous system. It is open to a large community of medical and scientific users, at regional, national and international level.

Neuroinfo has a 3T MRI installed at the Rennes University Hospital. In fact, this new Siemens Prisma 3T Magnetic Resonance Imaging (MRI) machine, which was installed in 2018, enables more data to be acquired in less time, and more detailed observation of human tissues. A team of research engineers supports users in their clinical and/or methodological research projects.

Neurinfo is a partnership between the University of Rennes 1, Inserm, Inria and the Rennes University Hospital, in association with the Eugène Marquis Regional Cancer Centre. Neurinfo is supported by the unit/project, VisAGeS U1228 INSERM/INRIA of IRISA.



ImmersiaVirtual reality at the service of medicine

Immersia is a virtual reality platform installed on the University of Rennes 1 campus. It makes it possible to move and interact within a virtual environment in relief, calculated in real time, by computer. This tool, supported by IRISA (Institut de recherche en informatique et systèmes aléatoires - Research Institute for Computer Science and Random Systems) and INRIA (French National Research Institute for Digital Sciences), already has applications in many fields including neurosurgery training. In fact, Immersia will be used to train teams in neurosurgical medical interventions. A virtual operating theatre will enable medical staff to move in an operating theatre and learn the procedures to use during an operation.

“The user puts him/herself in the place of a theatre nurse”, explains Bruno Arnaldi, Professor at INSA [National Institute of Applied Sciences] in Rennes. “This application will be used by student nurses because it enables them to role play; it is possible to simulate scenarios with high cognitive and emotional loads, situations that are in reality rare” (source: France Bleu article).

Laboratory : IRISA (UMR 6074) Centre Inria Rennes Bretagne Atlantique

Associated establishments : University of Rennes 1, CNRS, INRIA, INSA Rennes, ENS Rennes



THE CREATION OF START-UPS SUPPORTED BY SATTSATT Ouest Valorisation is supporting the creation of the Neurocort company, which specialises in the visualisation of the dynamics of the functional brain networks via an electroencephalogram.This start-up undergoing creation comes from the LTSI [Signal and Image Processing Laboratory] research laboratory. The Neurocort project is based on an innovative algorithm method for accurate analysis of the brain connectivity networks, as well as their evolution in time, by using HREEG (High Resolution).Firstly the method makes it possible to go back to the volume sources related to the signals measured on the surface, and secondly to determine the various networks activated in a reliable, robust manner. Finally, a specific algorithm has been developed for analysing the temporal dynamics of these demonstrated networks.

THE INNOVATIVE OFFER

The brain is a extensive body of neural networks. Identifying them and analysing their functional connectivity dynamics is a major challenge for improving knowledge about neurological disorders, the general functioning of the brain and even for developing diagnostic methods.These days it is recognised that neurological diseases are due to changes in these brain networks. Today, a number of methods and techniques are being developed to identify and analyse these networks so that changes in them can be observed. Amongst these methods, the surface EEG is an attractive choice due to its ease of use, its non-invasive, non-irradiating nature and its temporal resolution.

FURTHER INFORMATION

INTELLECTUAL PROPERTYBrain network dynamics

FR patent application filed on10/07/2015 (FR 15 56586)PCT extension in progress

EEGNET software, filed with APP (Programme Protection Agency)

on 16/07/2015 (N) IDDNFR.001.300011.000.S.P.2015.000.31230)

LABORATORIESLTSI (Laboratoire

Traitement du Signal et Image - Signal and Imaging Processing Laboratory) - UMR

INSERM 1099

APPLICATIONS

Neurological functional explorations using surface EEG measurements. The first clinical applications are focussed on :

Pre-operative planning for pharmacoresistant epilepsy

Early biomarkers in Parkinson’s disease

BENEFITS

Reliable, robust reconstruction of brain connectivity networks using surface measurements

Method based on a simple, inexpensive modality that is non-invasive for the patient

Visualisation of the high temporal resolution dynamics compared with functional MRI


THE EUROPEAN DIGI-NEWB PROJECT


Improving care for newborns as the result of a new generation

monitoring system

More than 300,000 newborns arrive prematurely each year in Europe. These premature babies have a greater exposure to infection risks (15-25%). Digi-NewB is a project financed by the research and innovations H2020 european program, the aim of which is improve care for newborns due to a new generation monitoring system. The project is focussed especially on improvement in the prevention of infections and in treating them, as well as better knowledge of baby development.

The Digi-NewB project, which began on 1 March 2016, is implemented by 7 partners in 4 different countries (France, Ireland, Finland and Portugal) over a period of 4 years. The project is conducted by the Groupement de Coopération Sanitaire des Hôpitaux Universitaires du Grand Ouest (GCS HUGO - Health-Care Cooperation Consortium of the University Hospitals in Western France), and supported by partner universities (University of Rennes 1, NUI Galway, Ireland, INESC TEC, Portugal and Tampere University of Technology, Finland) and 2 SMEs (Voxygen Health, France and Syncrophi, Ireland). The clinical study is implemented in the neonatology departments of 6 University Hospitals united in the context of HUGOPEREN, the children’s health research network for Western France (Rennes, Angers, Nantes, Brest, Poitiers, and Tours).

The aim of SATT Ouest Valorisation is to protect the project’s intellectual project.

Newborns observed during the study

People involved by the project

Countries involved

years

Partners

Final results



The main objectives of the project are the following:

To set up an important clinical study, the purpose of which is to observe more than 700 newborns in 6 different hospitals (Rennes, Angers, Nantes, Brest, Poitiers, Tours)

To identify the relevant parameters and develop composite indices which will be displayed on a dedicated interface in the neonatology units

To improve and validate the final decision making assistance system in terms of the relevance of the diagnosis and the experience of users, particularly in complex situations

This new system will provide new preventive and therapeutic strategies, will reduce late diagnosis of infections, and will improve the assessment of the child’s development

Project partner :

Source : Digi-NewB website

Groupement de Coopération Sanitaire des Hôpitaux

Universitaires du Grand Ouest

- FRANCE -Laurence Jay-Passot

Centre Hospitalier Universitaire de Rennes

Université de Rennes 1 - Laboratoire du traitement du

signal et de l’image

Tampere University of Technology

Voxygen INESC TECNational University of Ireland,

GalwaySyncrophi Systems Ltd

- FRANCE -Patrick Pladys

- FRANCE -Guy Carrault

- FINLAND -Alpo Varri

- FRANCE -Olivier Rosec

- PORTUGAL -Luis Antunes

- IRELAND -Gearoid O Laighin

- IRELAND -Gerard Lyons


THE RHU FOLLOWKNEE

THE RHU FOLLOWKNEE :MIXED REALITY IN THE KNEE SURGERY DEPARTMENTFollowKnee is one of the ten RHU (Recherche Hospitalo-Universitaire - Hospital and University Research) projects selected at the end of 2017 by the French government in the context of the Future Investments Programme. The aim of this e-health project : to develop a connected knee prosthesis intended to improve patient follow-up. FollowKnee, with a 5-year duration, is intended to provide concrete answers for each stage in the chain: improve the design, manufacture, insertion and personalised monitoring of implanted prostheses.

Laboratory : LATIM - Laboratory de Traitement de l’Information Médicale

Associated establishments: INSERM, IMT Atlantique Bretagne-Pays de la Loire, b<>com,

Immersion, Imascap, the SLS company, CEA Grenoble and ID2 Santé

THE OBJECTIVEFollowKnee was designed to revolutionise the treatment of the knee and the global treatment of the patient: prior to the operation to the post-operative follow-up. The task of the project partner, Immersion, is to study, design and produce the Mixed Reality experiment, which will assist surgeons in the operating theatre in optimising the insertion of this innovative prosthesis.

Photo : Immersion/anaelb.com

Some figures:

Duration: 5 years

Date of the start of the project: January 2018

Global budget allocated by the ARN (Association for Research in Neuroeducation): 24.5 million Euros

Financing: RHU/Investissement d’Avenir / ANR


THE RHU FOLLOWKNEE

THE LITIS LABCOMThe Laboratory for Interoperability, Processing and Integration of Health Big Data combines the LTSI and the ENOVACOM company, with the support of the University Hospitals of Western France, the University of Rennes 1 and Rennes University Hospital.

CONTEXTAfter the research work the LTSI developed an initial efficient tool for processing and using patient data known as “eHOP”.

In order to deploy this innovative tool in the six University Hospitals in Western France, and soon after in two Cancer Centres under the aegis of the HUGO (Hôpitaux Universitaires du Grand Ouest - University Hospitals of Western France) network of Clinical Data Centres coordinated by Professor Marc Cuggia, the University of Rennes 1, Rennes University Hospital and SATT Ouest Valorisation have signed an operating licence contract with ENOVACOM. This data warehouse completes its software suite for health data integration intended for hospitals. The partnership is therefore continuing with a synergy and willingness to develop new tools jointly.

The project for the joint laboratory (LabCom), “LITIS”, accepted and financed by the ANR, and resulting from a cutting-edge partnership

In 2017, the ANR agreed the creation of the LabCom, LITIS, managed by Prof. Marc Cuggia and supported by the LTSI Laboratory (INSERM – University of Rennes 1 with Rennes University Hospital), in partnership with ENOVACOM, publisher of software that is 100% dedicated to health and a leader in the communication and sharing of health data. It is intended for the design, development and deployment of new technologies for the integration and exploitation of this big data which is still over-partitioned today. It will benefit from ANR credits for three years.

THE OBJECTIVETo create future versions of hospital big data platforms used in Clinical Data Centres and devoted to medical research.

To do this the Labcom research and development programme is focussed on targeted integrative medicine projects in the fields of cardiology, paediatric intensive care and cancerology. The methods and technologies developed by the LITIS LabCom will benefit health establishments wishing to make the best use of their data in order to benefit patients.

Laboratory: LTSIAssociated establishments: ENOVACOM Company, INSERM,

University of Rennes 1, Rennes University Hospitals

AN ADVANCED PARTNERSHIPLITIS has the benefit of an exceptional environment combining the LTSI, a multi-disciplinary research laboratory of excellence in the field of health technologies UMR – INSERM – University of Rennes 1, the Rennes University Hospital Clinical Data Centre, which processes and exploits data from the establishment (1.6 million patients) and ENOVACOM, the leading French company for health data flow technologies, which is experiencing international development.


SATT Ouest Valorisation Offers companies innovative resources resulting from public research

OUEST VALORISATION, WHO ARE WE ?


OUEST VALORISATION, WHO ARE WE ?

TRANSFERS PROVEN TECHNOLOGIES & CUTTING-EDGE EXPERTISE

SATT Ouest Valorisation offers protected, fully developed and approved technology as a result of its huge investments in R&D to strengthen the technological leadership of companies.The SATT team provides solid answers to the R&D and innovation requirements of companies. It facilitates access to laboratories and simplifies the negotiation of contracts.

FACILITATES PUBLIC-PRIVATE RELATIONS

SATT Ouest Valorisation intensifies and diversifies the types of industrial co-operation to accelerate companies’ access to the technologies, skills and scientific equipment of public research laboratories.The team builds R&D programmes so that companies can move from the research results to the impressive pre-industrial prototype phase, and gain a competitive advantage.

IDENTIFIES AND PROTECTS RESEARCH RESULTS

SATT Ouest Valorisation identifies projects with strong innovative potential, assesses them and works with researchers to develop the best strategy for protecting and promoting them.The SATT team assists researchers on a daily basis, develops establishment portfolios of industrial property and broadens the socio-economic impact of their research.

VISIT US AT : www.ouest-valorisation.fr

Your SATT Ouest Valorisation contacts :

LOÏC NIOBESales [email protected]él : +33 (0)2 51 88 36 06

LOÏC DE MONTESQUIEUSales [email protected]él : +33 (0)2 99 87 46 67

CHARLOTTE DOUARDThematic Projects [email protected]él : +33 (0)2 99 87 56 19

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