Optical point-of-care imaging makes its impact in neurosurgery and beyond

07 Mar 2018

Cameron Piron of Synaptive Medical sees advances in optics and computing power coming together to benefit patients.

"The size of the market for optics in medical imaging dwarfs that for MRI, computed tomography, or ultrasound," says Cameron Piron of Synaptive Medical. "Optical techniques are not always considered to be the backbone of imaging in medical care, but they are."

As president of the Toronto-based medical device and technology company, Piron recently spoke to an audience who felt the same way. His keynote at SPIE Medical Imaging in Houston discussed the changing dynamics of the industry, and the expanding use of optical imaging to gather quantitative data at specific points in a patient's care cycle.

Synaptive Medical platforms include Modus V, a robotic digital microscope with hands-free automation for spine and brain surgeons, and BrightMatter, a suite of connected devices incorporating digital microscopy and data delivery to help neurosurgeons visualize a patient's brain during procedures.

Piron explained that strong synergies between the demands of surgeons and the advances being made in non-medical imaging have played a role in Synaptive Medical's development of these systems, and that the same synergies will boost future progress in point-of-care imaging systems generally.

"Medical imaging has suffered from a slowness to exploit advances in imaging after they have proven instrumental elsewhere. But we have the opportunity to take elements of imaging technology from areas like defense and advanced manufacturing, and apply them to surgical techniques where the benefits will be readily apparent," he commented to Optics.org.

In an example of the kind of benefit Piron describes, his company collaborated with Canadian Space Agency contractor MacDonald, Dettwiler and Associates (MDA) to create an automated robotic arm that tracks the movement of a surgeon's tools during brain and spinal surgeries, a new use for robotic technology originally developed by MDA for the International Space Station.

The film industry is another sphere where significant recent improvements in image quality and color calibration, like the ones under development for the IMAX format, could now be valuable in surgical applications.

"It's important that surgeons have a platform that can receive data from multiple sources — whether from optics, or MRI, or CT — to facilitate better clinical decisions," Piron noted. "One focus of our efforts is creating the data sources themselves and improving the quality of the information they deliver, through better resolution or color imaging, while a second goal is to develop new architectures and infrastructures able to deliver the data to surgeons."

Some of those data sources may be relatively new to brain surgeons, but already familiar to clinicians elsewhere. OCT and Raman spectroscopy both have established roles in sectors such as ophthalmology or pharmaceutical quality control, but have not translated far into neuroscience, the area where Piron's company is now bringing them both to bear.

Synaptive Medical's founders originally worked together at Sentinelle Medical, a company focused on the use of MRI for breast and prostate imaging, before they identified opportunities for the same skill-set to make an impact in neurosurgery by improving the quality of imaging and integrating it into the operating sequence. This was an aspect where progress had not been rapid, according to Piron, who commented that the surgical microscope first translated into clinical use 50 years ago but had then remained substantially unchanged since.

The evolution of medical optics
"Surgeons have adapted to that equipment, but the equipment has not really adapted to what surgeons need, which are decoupled and optimized optical imaging systems able to provide better clarity and magnification," he said.

"That was the opportunity that first led Synaptive Medical into becoming an optics company. The information acquired at the point of surgery is typically analog, via the surgeon's eyes, but this is the perfect point at which to integrate digital technology and pull advanced imaging into the surgical field. Linking that information directly to patient outcomes is at present an under-explored area, and very much the focus of point-of-care imaging."

This goal also fits the current trend towards more proliferated use of imaging in medical scenarios generally, as it moves beyond a traditional home in radiology departments and becomes distributed throughout different hospital functions. Stroke care provides a clear example, where imaging techniques are now being more readily applied during the critical period between diagnosis and the start of therapy, allowing faster interventions to be made on patients.

"The trend will be for the costs and accessibility of imaging to improve — not just the cost of the equipment, but also the cost of gathering the data," Piron commented.

"The more we integrate the acquisition of this information into the clinical flow, the more cost-effective it will become. This means that machine intelligence and related technologies will be a big focus. Data sets will become not just bigger but better, and suitable forms of intelligent analysis and AI will have to evolve in parallel. We will also have to consider the ability of clinicians to consume the data, and how to make it both effective and straightforward to interpret. These trends are already in place, and will continue over the next ten years."

At the same time, novel techniques such as photoacoustics will begin to play their part, and point-of-care imaging will ultimately exploit convergence between multiple different modalities — OCT, infra-red imaging, Raman spectroscopy, hyperspectral imaging and others — as they all become integrated into clinical pathways.

"There has been a realization on the part of several traditional optics companies that the lensing technologies of the past are probably not the way we will create better medical imaging in the future," said Piron.

"Instead it will be software architectures, better detectors, and automated systems that will bring about the next steps in the evolution of medical optics. The technical and economic factors that can allow medical imaging to fit smoothly into a continuum of interventional and point-of-care medicine started to take shape decades ago, but the process is entering an exciting phase of exponential acceleration now."

About the Author

Tim Hayes is a contributor to Optics.org.