Category

News

10 Questions with….. Fabien Scalzo

By | Expert Series, News

Fabien Scalzo is an Assistant Professor at UCLA and Director of the AI in Imaging and Neuroscience Lab there. He develops Machine Learning and Computer Vision algorithms to better our understanding of neurological disorders particularly Stroke and traumatic brain injuries (TBI). He does this using brain mapping of imaging and biosignals.

So Fabien, how did you come to do what you do today?

I was trained in computer vision and machine learning at the University of Liege in Belgium and carried out research to build new algorithms for visual learning. I became fascinated by how we perform these visual tasks as humans and interested to learn about the learning mechanisms in the brain. This was a big inspiration for my PhD work and one of the reasons I later joined   the department of neurology and neurosurgery at UCLA. This was 10 years ago, when I realised that machine learning, although had its limitations, could really make a difference for clinical care. 

Why do you think AI has proven so transformative to medical imaging and why is this particularly the case in something like stroke?

With stroke, it wasn’t even clear 10 years ago that imaging would be helpful in guiding decisions and there was a lot of controversy regarding the value of it. With machine learning, we let the computer figure out the patterns that really matter by retrospectively analysing the outcome of hundreds of patients. It reduces the manual information and the prior assumptions that we need to input and because we make better assessment of the patient, thanks to the algorithm, the patient may have access to the best treatment option; the one with the highest likelihood of good outcome. Machine learning streamlines automation and has an ability to extract information that we would not be able to comprehend or even visualize, making it accessible to clinicians.

What do you think about the hesitation to AI in the medical field? Where do you think it comes from?

One part of this is tradition. The medical field has operated in a certain way for so many years; very successfully in many cases. There is also a hierarchy amongst doctors and bringing on board a machine that is part of the decision process can be met with scepticism and in some cases it’s valid. There is a need for understanding what that machine is doing, I don’t mean being able to code it but get a grasp of the structure and the rationale behind its diagnostic output. 

What do you think needs to be done to reduce this?

The clinicians need to be able to give trust to the machine learning model which comes with having a good general understanding of it. Also regulation through the FDA is becoming even more important because they are the only organisation that the clinician can trust to adopt and regulate these tools. I think we need to customise special tracks for approving machine learning tools. These are very different from anything we’ve worked with before so even though it may fall within the category of a medical device there is another dimension to it. I see far too often clinicians taking for granted the ability of machine learning to always give the perfect answer and then if it gives a wrong prediction they immediately lose their trust in it. There is always some uncertainty and that’s ok as long as we are aware of it. I try to tell people it’s not perfect, it has its own weaknesses but as long as you know when that happens and what to look for, it is still useful.

Do you think there are issues with transferability from different technical perspectives?

Yes totally. There was a very big hurdle because we have two very different worlds trying to come together. On one side we have the clinical world which measures the value of the technology by how much it improves the care of the patient and the workflow. On the other side, the machine learning scientists normally measure usefulness  by how well the model performs with certain types of accuracy metrics. Even though these metrics may work well in the experimental setting it may have zero impact when transferred into clinical care. This is something I’m working on, trying to evaluate the machine learning not only with respect to the accuracy of the models but with respect to the clinical value in terms of decisions and workflow.

Do you think in the next 5 years we are going to see big changes in the merge of these two worlds?

Yes machine learning is very young and novel and will continually improve. At some point, machine learning will be at least on par with the best neurologists in the world for diagnosis so in that sense it’s going to be very interesting to see how it develops. At the moment all the models we have are extremely specialized for specific tasks but I think eventually models will develop to be more versatile and general so a neurologist will be able to see things that previously would have been missed. And some of that is not part of machine learning, it is common sense so eventually we want to bring common sense to the machine!

Is the best of AI currently in medical imaging or is it to any extent behind because of the difficulty with patient data and accessing it?

Today if you compare the magnitude of data in medical imaging to marketing/advertisement, we have extremely small data sets and they are for very heterogeneous diseases, where every patient is different. There are a lot of issues regarding privacy which need to be addressed. We are behind because we rely on data coming from a medical provider, such as a hospital, but across the world they do not have the infrastructure to deal with large amounts of data in an efficient way so that slows things down.

It is great that there are so many new companies like Nico.lab that build around existing infrastructure in the hospital, which makes it easily accessible to all physicians and renders the process of using data in a transparent and secure way which is what we need right now. 

If patients were more comfortable with sharing their data for research would this have a positive impact on AI?

Yes millions of people will benefit from sharing your data so it’s increasing awareness of that and working out an infrastructure that will make people feel comfortable about sharing it. But I think it will be a gradual cultural shift. 15 years ago Google was using our data and there was a big backlash but now most people don’t mind about that to some degree. It is part of the world we live in, as long as it is recognised and we know how it is used in a positive way toward betterment of society I think it is acceptabe. But some would disagree and that is also ok! One should have the right to not share their data. 

On a personal level, what is the most exciting aspect of your work?

Well two things. You can use machine learning to do finance and make a lot of money but you can also use it to save lives and that is what excites me the most. To be more precise I am very interested in stroke because it is a disease that is extremely hard to understand – some patients may return home with almost no side effects and others may not survive. It is phenomenal that soon we will be able to predict accurately the outcome of a patient for a given treatment course. This works because machine learning can incorporate data from so many patients with different treatment options so eventually the model will be able to make simulations of the likely outcomes for different treatments including the different benefits versus risks. It will be truly personalised medicine!

As well as prediction, all the different elements of AI streamlining and speeding up care will improve healthcare systems as a whole but do you think that AI will also save money?

Yes, AI will make the whole process from reading images to treatment much more efficient therefore reduce time and make work easier and more pleasurable for neuroradiologists which will of course reduce costs. It seems obvious to me but i guess it depends on how versatile the model is. If it is only for stroke, you need another one for cancer and screening brain injuries then you will be surrounded by AI. Versatility and some AI is a good direction in the future where we will have a model not just for stroke. But we are not there yet, we are in different compartments, but eventually I hope we can bring it together.

Nico.lab improves clinical practice with innovative and trusted AI. Our product StrokeViewer, is an AI-powered clinical decision support system, offering a complete assessment of relevant imaging biomarkers within 3 minutes.

10 questions with….. Albert Yoo

By | Expert Series, News

Dr. Albert Yoo is currently an interventional neuroradiologist, Medical Director and Director of Endovascular Fellowship & Research at the Texas Stroke Institute. He is an incredibly knowledgeable figure in the stroke world after his many years of research and training. He has participated in several major trials of intra-arterial stroke treatment, including MR CLEAN, THERAPY, MR RESCUE, DAWN, ARISE II, and GOLIATH trials. He is currently involved in the TESLA trial which he sheds more light on during this interview. 

How did you come to do what you do?

I stumbled upon it. I was always interested in Neurosciences. In medical school it was a very hard decision between becoming a neurologist, a neurosurgeon or a neuroradiologist. But during my neurosurgery orientation I saw the interventional suite and it was pretty soon after that I realised it was my path because it’s a nice intersection between imaging and therapy. 

After the dust settles, which stroke biomarker do you think will prevail? 

I am impressed with the simpler imaging approaches. A non-contrast CT and CT angiogram are very powerful tools. Part of their power is that they are available virtually everywhere and as we think about moving the field forward not only should we ensure that our imaging selection does not exclude patients who might benefit, we should keep an eye towards standardizing treatment decision making and delivery across all stroke centres.

Do you expect that collateral assessment like multiphase CTA will ever go out of fashion, and if so do you ever think that’s justified? 

Obviously collaterals are important because they sustain the brain tissue until the occlusion is recanalized. However, the clinical question is whether we need to be so fine in grading the strength of the collateral perfusion. I don’t think so. If you have a measure of the infarct size with ASPECTS and the infarct is not too big, then as far as collateral evaluation, all you need to exclude is the complete absence of collaterals. If there are no visible collaterals, patients will not do well regardless of rapid reperfusion as MR CLEAN and other studies have shown. Otherwise, it doesn’t matter whether the collaterals are intermediate or robust because in either case there is treatment benefit. I believe that traditional single-phase CTA is sufficient to say whether the collaterals are absent or at least partially present.

If there was a large increase in the use of MRI in acute stroke care across the world, due to increased availability for example, would you be happy with this and why?

Yes I think MRI is the most accurate imaging modality for determining the size of the infarct at presentation and to me that’s a key imaging finding to decide whether or not to pursue treatment, but as you are alluding to there needs to be improved availability of MRI as well as faster MRI workflow. With clinical experience, centers can have treatment times with MRI that are just as fast as with CT. This was shown in the recent GOLIATH trial that was conducted at Aarhus University hospital which uses MRI as their primary imaging approach. 

Do you think there is still a space for EVT patient selection within the 6-hour time window?

Within the 6-hour time window you need to have a very strong reason not to treat. That being said imaging is still necessary. You need a CT scan to rule out hemorrhage, and this same scan will tell you whether the ASPECTS is too low. You also need a CTA to evaluate the level of occlusion, and this scan will tell you whether the collaterals are absent. When it’s early you pretty much have to have evidence of zero collaterals or a very large stroke to not go to the angio suite. Fortunately, CT/CTA is very quick to perform. 

You are working on the TESLA trial, a very exciting project which could potentially have a huge impact for the field, what outcome are you hoping for and why? And what do you think the outcome will mean for the role of ASPECTS in stroke?

As an interventionist my hope is to provide evidence that expands the treatment population. We have very strong evidence in patients who have small infarcts and good collaterals. What is uncertain is whether patients with moderately large to very large infarcts will have a benefit with rapid reperfusion. I think there is a subset there which will benefit just based on the existing data, and probably many of these patients are not being treated currently.

Paradoxically, it will make ASPECTS more important because the trial will have established a threshold ASPECTS value that is critical for determining treatment response. At the same time, there would be a rationale to test whether more advanced imaging modalities can identify subgroups within the low ASPECTS population that might respond to treatment.

Recently there was a large Chinese trial that showed the non-inferiority of Direct EVT which was a pretty big deal, do you think this result will hold up in other trials? 

It’s important to remember that this trial only applies to the subset of patients who present directly to the endovascular centre where the time period over which IV tPA has a chance to work is very small, so it’s a result that is not surprising and I’m sure it will be confirmed in future trials. I think the key point to remember is that IV tPA is still useful in patients who are being transferred (drip-and-ship patients) for consideration of endovascular therapy. The real question is how does this trial result change practice for patients who present front door (direct admit to Endovascular Center)? There is a rationale based on cost to just forgo the tPA but cost issues aside there were still signals of benefit for tPA for early recanalisation obviating the need for intervention and overall reperfusion. In addition, there may be patient subgroups that might benefit from IV tPA that could not be detected with adequate power such as those in whom the occlusion cannot be reached. Also remember this is a moving target. It is likely that we will be using tenecteplase instead of alteplase soon. Do these results apply to tenecteplase? Probably not because we know that tenecteplase performs better than IV tPA for endovascular eligible patients. About 75% of subjects in EXTEND-IA TNK received intravenous thrombolysis at the endovascular centre.

EXTEND-IA TNK showed significant benefit of tenecteplase over IV tPA as a bridge to endovascular therapy. In more general stroke populations, there is strong evidence for the noninferiority of tenecteplase. Taken together, there is sufficient evidence to support using tenecteplase in place of alteplase. The fact that tenecteplase can be given as a single bolus dose further adds to its clinical utility.

What are your thoughts on nerinetide? Do you think it has the potential to be a game changer?

Neuroprotection as a bridge to intra-arterial reperfusion is a very attractive idea. This concept was tested in ESCAPE-NA1. Unfortunately, the primary analysis of this trial was neutral. The secondary finding that benefit was seen only in patients who did not receive bridging alteplase must be regarded as exploratory and requires confirmation. I believe that a subsequent trial is being planned in the IV tPA-ineligible population.

How do you think artificial intelligence benefits acute stroke care?

I think it works brilliantly as a screening tool to alert the team that there is high suspicion of LVO. The communication gets everyone coordinated in a parallel fashion. From the early experience at our center, it seems to really help with the workflow and speeds the time to intra-arterial treatment. Of course, the algorithms are not perfect but they don’t need to be. They just need to screen and capture most patients so that the LVO can be confirmed by the physicians. It is likely that AI will become increasingly involved in the actual selection of patients. We are seeing this in the realm of CT perfusion. In my opinion CT perfusion over selects — it selects patients away from treatment that should be treated and there is evidence to that effect. But I think AI algorithms as applied to imaging findings on noncontrast CT and also CTA collaterals will be very helpful. If you have a tool that has been validated to accurately tell you that the ASPECTS score is this or the CTA collaterals are not absent then it becomes a tool that can standardize treatment decision-making across centres. I think there are a lot of things that will continue to develop as these tools are utilised more and more.

Do you think covid-19 will have a positive or negative effect on progress of stroke research in the future?

I think it’s too early to say. Certainly, in the short-term there’s been a major impact. What we’ve seen in TESLA is that stroke volumes are down broadly. I think the likely reason is that patients aren’t seeking care as aggressively as they used to out of fear of coming to the hospital. But the crisis has highlighted opportunities to improve trial methodology in the future. As one example, we are finding that centers are now adopting electronic consent as a means to enroll patients whose LARs are not able to be in the hospital. This will help enrollment beyond the Covid-19 era.

Do you think it’s better to focus on complex stroke imaging techniques which will have a greater effect on the Western world or is it better to focus on more pragmatic techniques that would benefit more broadly including developing countries?

This is an issue that I think is so important. Many physicians in First World industrialized nations get very enamoured with advanced imaging technologies just because they are advanced and provide an “easy” answer. But I’ve studied the spectrum of acute stroke imaging over the past decade, and I find that the “easy” answer particularly as it relates to CT perfusion is often wrong and tells the physician to not treat when in fact the patient should be treated. The major misconception among physicians that use CTP is that perfusion can tell you whether the tissue is dead. This is obviously wrong. CTP forecasts tissue viability but just like the weather, the reality is often very different. Numerous studies have demonstrated this. 

The simple imaging techniques are powerful for multiple reasons. First, because noncontrast CT images ischemic edema which is a sequelae of neuronal death, it can tell you with a high degree of confidence whether the brain tissue is dead. Second, CTA is an efficient means of identifying the location of the occlusion and whether the collaterals are futile. Third, these tools are low cost and available to any hospital. I believe as a field that we should be rooting for these simple, pragmatic imaging approaches if we are going to impact care around the world, particularly in less developed countries. Clearly, doing a noncontrast CT and CTA is much more feasible than doing advanced imaging like CT perfusion or MRI. Committing resources towards developing AI algorithms that are based on the simple, pragmatic imaging approaches I think is very important as they will help to standardize treatment delivery worldwide.

 

Nico.lab improves clinical practice with innovative and trusted AI. Our product StrokeViewer, is an AI-powered clinical decision support system, offering a complete assessment of relevant imaging biomarkers within 3 minutes.

Nico.lab is selected for the Techleap.nl Rise Program

By | News, Press Release

AMSTERDAM, 28 MAY 2020

Nico.lab has been selected for Techleap.nl Rise program, the showcase for future unicorns

The Netherlands, under the Techleap.nl-program, has officially launched Techleap.nl Rise. With this ambitious programme, Techleap.nl and top entrepreneurs like Pieter van der Does (Adyen), Ali Niknam (bunq), Steven Schuurman (Elastic), Chris Hall (Bynder), Michiel Muller (Picnic) and Gillian Tans (Booking.com) are helping the most promising scale-ups in the Netherlands to grow faster internationally. Scale-ups participating in the first batch along with Nico.lab are: Easee, Floryn, LTO Network, Mapiq, Online Payment Platform, Polarsteps, Quicargo, Starred and Wizenoze.

As part of the programme, we will be put on the international map with corporates, investors and media. We are encouraged in groups of ten to fifteen participants to also learn from each other about the challenges of scaling up a company.  We will receive support and feedback from top Dutch entrepreneurs who share their own insights and lessons learned with the new batch of promising scale-ups. Every quarter Techleap.nl Rise will help a new group of entrepreneurs.

Merel Boers, CEO Nico.lab: ‘We are so thrilled to have been selected as one of the highest potential scale-ups in the Netherlands. We are looking forward to cooperating with the other talented entrepreneurs to learn and grow together, taking the Dutch tech world to the next level!’

Two unicorns a year, best ecosystem in Europe
The aim of Techleap.nl Rise is to support the emergence and development of world champions in the technology sector, to become less dependent on technological solutions from other countries and to create a climate in which two unicorns per year can ‘rise’. By 2023, Techleap.nl Rise wants to have supported 250 promising scale-ups. The insights from the program will also be shared to further improve the tech-ecosystem in the Netherlands and to define bottlenecks and solutions for the growth challenges of scale-ups.

Strict selection
The criteria to participate are strict: a scale-up qualifies for the program if they meet the following criteria: currently €10M+ is being raised in a funding round or they are preparing to raise it with their next round (which has probably already been funded €1-5M); an annual turnover in excess of €1 million; more than 10 FTEs employed; at least 50% annual growth and a clear understanding of the product/service and the market they serve. 

Constantijn van Oranje, Special Envoy Techleap.nl : “With Techleap.nl Rise we want to create more Dutch technology companies that can measure themselves against the best internationally. We have found the best entrepreneurs in the business willing to help our most promising scale-ups with honest hard and constructive feedback. By learning from each other’s experiences and connecting them to the right parties, we create an innovative climate in which the tech leaders of tomorrow can rise above themselves.” 

Gillian Tans, Chairwomen Booking.com : “The Techleap.nl Rise program allows me to give back the insights of my own scaleup journey with Booking.com to today’s most promising companies.”

Koen Droste, CEO Polarsteps: “Techleap.nl Rise is important to us because it paves the way for us to the international tech scene: from investors, to media and techtalent. We expect the program to have a real impact on the growth of our company through the connections we can make.” 

Read more about the selected scale-ups and the program here.

Nico.lab join forces with expert partners to fight Covid-19

By | News, Press Release

Nico.lab is proud to announce the establishment of the ICOVAI consortium; a collaboration between science, clinical and technology experts. We believe AI can relieve some of the overwhelming pressure on medical staff and together will develop a valuable not-for-profit solution. The goal of ICOVAI is to support medical staff during the crisis by developing and deploying an AI solution for triaging and risk stratification of COVID-19 patients.

We see an increasingly clear case for using chest CT scans to assess the severity of COVID-19 and the likelihood of patients requiring ICU care. We recognised that our understanding of the clinical workflow and experience in developing AI for CT coupled with that of consortium partners can be leveraged to increase the speed and accuracy of these assessments during this critical time. 

About ICOVAI:

  • ICOVAI is a not-for-profit initiative aiming to leverage experience and knowledge of consortium partners in  the fight against Covid-19. 
  • ICOVAI aims for fast development and implementation of an AI-powered solution to help healthcare professionals deal with assessing the severity of COVID-19.

Deployment at scale in clinical practice

Beyond development, ICOVAI is well-equipped to validate and deploy the AI solution at scale across hospitals in Europe, aiming for these key results: 

  • European adoption and safe use of AI in COVID-19 triaging and risk stratification 
  • Increase speed and accuracy in COVID-19 triaging and risk stratification 
  • Reduce workload in COVID-19 imaging workflow

The COVID-19 pandemic is endangering people and healthcare systems across the world. AI has the potential to guide rapid decisions on patient care, risk management and hospital planning. To make a contribution during this crisis, we need to act quickly and work together.

More info on ICOVAI here→ https://www.icovai.org/

WE NEED TO FIGHT COVID-19 TOGETHER.

10 Questions with….. Ivana Išgum

By | Expert Series, News

Ivana Išgum is the University Professor of AI and Medical Imaging at the Amsterdam University Medical Center.  Graduating in Mathematics from the University of Zagreb in 1999, Išgum became a PhD student in the Netherlands in 2001 at the Image Sciences Institute. Obtaining her PhD degree in 2007, titled ‘Computer-aided detection and quantification of arterial calcifications with CT,’ Ivana then worked at both Leiden University Medical Center and UMC Utrecht, before embarking upon her position at the AMC.

Why do you do what you do?

Growing up in Croatia, both my mother and father were engineers. I remember being taken to my father’s work as a little girl and finding the whole experience and atmosphere so exciting. I knew I wanted to follow in my parents’ footsteps. I  came to the Netherlands 20 years ago as part of my journey to pursue that goal and never left.

Studying mathematics was quite abstract for me. I think that math is everywhere around us but we’re often not aware of it. It is fulfilling for me to connect knowledge with something that is applicable and visible in everyday life. So, I wanted to do something medical.  I wanted to strive for an academic career and surround myself with inspiring people. Of course getting funding for the research we want to do can be a struggle, but ultimately my job comes with the capacity to work on what I wish to work on, there is such creative freedom.  

How has AI proved so transformative to medical imaging? 

It has been the appearance of deep learning and the ability of algorithms to now be able to learn from the data themselves that has boosted the field enormously. Whilst AI is everywhere and indeed everyone is excited about it, for some this may appear as ‘hype’, but I really try to avoid using the word ‘hype’.  It implies that after a few years AI will somehow go away. That’s not the case, I am convinced that AI is here to stay, it will develop further, and it will radically change the way we work. 

Unlike in other industries, in the field of medicine we seem to not be as far as we could be. The main reason for this is probably accessibility of data. AI requires large sets of data that represents different populations. Furthermore, responsible application of AI in clinic while adhering to privacy legislation and ethical standards is far from trivial.   We are actively researching these issues so that the medical field can benefit from current AI much more than it’s already doing.

In a broad sense, how can AI currently benefit healthcare systems? 

Current healthcare systems are not sustainable as they are. The number of medical experts is limited and AI can help relieve their burden. AI might save costs, but it will more likely allow for a more sustainable system and it will certainly enable expert healthcare to be brought to parts of the world where there is a shortage of expertise. 

Where does reservation around AI stem from, and how can it best be addressed? 

One of the fears of AI comes from the caution of un-transparent decision-making. There are big, important and needed conversations currently going on about this. As experts, we do have to look at causality and make sure we validate thoroughly. I think the general public have a fear of AI being depersonalised but I don’t think it necessarily is, or should be. 

Are mindsets becoming more confident in AI powered tools in clinical practice? How does that feel for you at the forefront of research?

More people are seeing the potential benefits of AI to the future of healthcare, and resistance is decreasing. But  people generally resist change, if you look back at history it’s always been the way. Five years ago, people were panicking that radiologists would be replaced, and therefore not trained and that we’d see the takeover of robots. Now that hasn’t happened and undoubtedly never will. The medical world moves slowly and AI brings added value to routine work that radiologists can partner with and check. Ultimately AI makes it faster, more reproducible and cheaper than clinicians doing it all themselves, and that creates impact. 

Physicians understand AI in medical care is here to stay and people want to ride the wave. It opens the door for so many opportunities and for us who have been in the field for a long time, it’s rewarding. 

Where are we currently in terms of the potential of AI being utilised in clinical practice and what are the key challenges when it comes to implementation? 

From a research perspective, you see that a lot is possible. I would say the technology to answer many questions is available. But if you look at the products, the diversity doesn’t match up. For example the number of AI powered radiology tools used on a large clinical scale, is not very many, if at all. So the translation from research to clinical practice is really important. Regulatory bodies such as the FDA for example, are changing their strategy quite considerably in order to keep up with regulations that enable these tools to come into use.

Careful implementation is crucial. We cannot make mistakes. It’s important to consider all aspects of AI application including associated ethical and legal issues.  We are working with an extremely powerful tool and sensitive data; there is a lot to be discovered. Whilst we want to utilise AI to find information which is important to be found, we do not want to generate investigations which are not needed. These are all issues that are fundamental as we explore the possibilities of translating research into clinical practice. 

What do you think are the main technical challenges related to applying AI to medical imaging in comparison to using AI in other fields?

Medical image data is large and high dimensional, often 4D and 5D. At the same time, there are small sets of labelled representative data to learn from and the labels are often noisy. This can be challenging for analysis. Furthermore, data is quite diverse regarding image acquisition protocols, variability in anatomy and pathology. Designing methods that are robust to all these is not straightforward.

After the introduction of deep learning, there was a boom of papers applying similar techniques to different domains. Has the rate of progress slowed down or are there new interesting challenges that (if solved) could represent a major milestone in the field of medical imaging processing?

I am not sure whether the rate has been slowing down. We see that methodological developments from one research domain are being adjusted for application in others, which is good. However, we also see enormous competition in publishing where outperforming previous work, even if very slightly, is expected. While improving on the performance is possibly important and relevant, I think it is even more important that these are reproducible and that we try to understand why some approaches work better than others. 

What’s next in terms of key medical areas to benefit from AI?

It’s such an exciting time, we’re at the tip of what’s possible. There are very many possible applications of AI in medicine.Not only analysis of medical images but  the merging of different types of information can be very impactful and could help deeper understanding greatly.

As a successful woman in the field of AI, you must get asked about gender dynamics a lot, do you feel this question is still useful? 

Absolutely, it’s an incredibly important but sensitive issue. I dislike when people say it’s not a problem or that it’s not a problem for me any more. That is just not true. Ultimately we do not have enough women in science. As a society we are educating women but missing out on benefiting from their talent. Why? It’s such a complicated myriad of things at play (such as PhD and PostDoc timing coinciding with starting families, judgement in the workplace, at home, in the school playground etc) that ultimately work together to prevent society not utilising the full capacity of experts trained in science. 

Diversity is key for benefiting science. Some people say we need to encourage women, I think it would be a start if we didn’t discourage them.

Nico.lab improves clinical practice with innovative and trusted AI. Our product StrokeViewer, is an AI-powered clinical decision support system, offering a complete assessment of relevant imaging biomarkers within 3 minutes. 

10 Questions with….. Wouter de Monyé

By | Expert Series, News

Dr. Wouter de Monyé is the Medical Director of Radiology at Spaarne Gasthuis. Having graduated from the University of Utrecht in 1996, de Monyé went on to carry out research at Leiden University Medical Center and trained as a radiologist at Leiden University Medical Center and Royal Liverpool University Hospital.

Why do you do what you do? 

My motto first and foremost is to make people better. It’s a broad ambition but importantly it’s not just patients, but people, I strive to better. That’s why I love to teach and train within the hospital. I want to help my fellow medical colleagues come to patient diagnoses faster and more efficiently. 

What was your first job?

Funnily enough, cleaning a hospital when I was 15 years old.  My mother was a nurse and set me up waxing those long corridors. As a child I wanted to be a pilot, but this soon developed into the desire to become a flying doctor. You need to become a doctor first and the aviation part comes later. In the process, I discovered that radiology was my calling. I built computers on the side for a bit of extra money during my studies, but soon had to give this up when I started my research at Leiden University. 

What has been the highlight of your career so far? 

Becoming the Medical Director of my department. This has allowed me to influence systems and process and improve the circumstances we work in as doctors. At some point you think you’re doing your job and you’re being a professional, but ultimately it’s the same process time and time again. If you manage to get a helicopter view, you can see structural changes that could benefit not only one person, but a cohort of patients. I find being able to influence such change extremely rewarding. 

What is the most challenging aspect of your job? 

Getting the diagnosis right, particularly in acute situations. As a radiologist, you need to be able to ascertain what’s normal and abnormal and stick to it. But you also need to be able to know when to convey doubt. That’s the tricky part, especially when you don’t have time for a colleague to have a second look. Sometimes doctors put you on the spot – is it this or is it this? You find yourself having to give black or white answers in situations which are often pretty grey. 

Do you have any coping mechanisms for dealing with the stress of your profession?

That’s difficult to answer. I guess realising life can be over in the blink of an eyelid makes you focus on trying to build its most important elements,  like good relationships and friendships. 

Why is timely diagnosis so urgent in stroke?

The challenge to get things right is critical. Stroke is pretty common and its impact can be huge – everlasting, for the rest of a patient’s life. Quick diagnosis is key, but more and more research suggests even in cases with a larger diagnosis time interval, there is still benefit from intra-arterial thrombolysis. So having been proven in the Mr Clean trial that in acute situations this type of treatment option works, I think we’re now working towards expanding this approach to more patients. We’ll be seeing more situations whereby a possible clot has a chance to be treated in this novel way. I think the Mr Clean trial gets more relevant every year. 

Are there any challenges in the current stroke workflow? 

Getting the knowledge to the image, or the image to the knowledge. Doing the actual scans is no longer a problem. These days the CT scanners are able to produce high quality images in a very short amount of time. The challenge is interpretation. Those many images need to be analysed by an expert. Such professionals (ideally a neuroradiologist) are not always on call and a patient’s scan will often have to be interpreted by colleagues with less professional experience. 

Why is improving image sharing so vital? 

A waste of time is a waste of brain. If we can get an image to an expert as quickly as possible, that can be life altering for a patient. If a colleague needs help with interpretation, the current standard way of sharing images is difficult if you’re relying on your old fashioned Pacs system. You receive a call when you’re out and you have to go home, load up your computer, get the images up-  this can easily lose you 15 minutes which is absolutely critical. The shorter the door to needle time, the better the result. With StrokeViewer, I can immediately receive a patient’s CT scan on my mobile phone wherever I am. That saves time by enabling me to interpret the high quality images on the spot. It’s amazing and something I’ve never experienced with the regular Pacs system. Seamless image sharing makes everything so much easier. 

What are your thoughts on the added value of assisting image interpretation via artificial intelligence? 

 Assisting interpretation of CT images via artificial intelligence brings the bottom of quality up. It raises the bar.  If for whatever reason (timing, location etc.) a less experienced radiologist is interpreting the scans (which is common), AI can help him or her perform like an experienced radiologist. That’s something which is really becoming clear from Strokeviewer and is so helpful. As with any relationship, it takes time to build a relationship of complete trust. And similarly with any new technology, AI will need to prove itself in clinical practice. But we are currently seeing real life applications of artificial intelligence and it is amazing how fast my colleagues are beginning to rely and trust in it. It’s definitely going in the right direction.

How would you describe the current relationship between radiology and artificial intelligence? And how do you see this progressing? 

In radiology we’ve had digital images for quite a long time, more than 15 or 20 years. Even in the early stages there were various computer aided detection promises. But it’s only very recently, in the past 3 or 4 years, that deep learning and artificial intelligence, actually make possible what was promised all that time ago. I’ve worked with systems which have tried to do similar things but in a poor way. As with any relationship, it takes time to build a relationship of complete trust. And similarly with any new technology, AI will need to prove itself in clinical practice. But we are currently seeing real life applications of artificial intelligence and it is amazing how fast my colleagues are beginning to rely and trust in it. It’s definitely going in the right direction.

 

Nico.lab improves clinical practice with innovative and trusted AI. Our product StrokeViewer, is an AI-powered clinical decision support system, offering a complete assessment of relevant imaging biomarkers within 3 minutes.

 

StrokeViewer launches in North-Holland and Flevoland

By | News

Nico.lab is excited to announce that this week StrokeViewer®️ was launched in the North-Holland and Flevoland region in the Netherlands, covering 10 hospital sites. Using advanced Artificial Intelligence (AI) techniques in an innovative cloud infrastructure, StrokeViewer allows for faster and more accurate treatment decisions. This regional approach in using AI to improve the stroke workflow marks a new chapter in improved patient care. 

In the highly acute setting where every minute counts, StrokeViewer instantly alerts radiologists that brain scans from a suspected stroke patient are ready for review. The physicians are then able to immediately view the images wherever they are, even on their mobile phones, saving precious time. The AI immediately shows crucial information on the type and severity of the stroke, which allows for a quick and accurate decision to be made on the best course of treatment.

In many cases the patient must then be transferred to the regional Intervention Center to receive specialised treatment. Until now the region has struggled to safely and quickly transfer the medical images to the treating hospital, a crucial step in allowing Interventional Radiologists to plan surgery before the patient arrives. StrokeViewer uses an innovative cloud infrastructure, which allows peripheral hospitals to securely share medical images in minutes with the treating physicians. 

Nico.lab believes that only through an integral approach addressing the entire stroke workflow significant improvements can be made. That’s why StrokeViewer not only comprises cutting edge AI algorithms, but embeds them in an innovative IT infrastructure that makes life easier for the radiologists. Through this technology and the regional collaboration Nico.lab hopes that many patients recover better and faster from stroke. 

 

Amsterdam UMC and Nico.lab awarded grant to improve stroke treatment with AI software

By | News

Amsterdam UMC and Nico.lab received €800.000 from the Dutch Ministry of Economic Affairs. This subsidy was awarded to develop Artificial Intelligence (AI) methods to accelerate Magnetic Resonance (MR) imaging and analysis in stroke victims using the Google Cloud Platform. The project aims to enable hospitals to acquire brain scans ten times faster, making MR suitable for the acute clinical setting where minutes matter. With this grant, the consortium aims to improve the complex decision-making in stroke and shorten the time that is needed to initiate appropriate therapy, thereby improving the quality of life after stroke.

Fast diagnosis and treatment is key when suffering a stroke to prevent irreversible cell death and concomitant brain damage. CT imaging has been the predominant modality of choice for diagnosis and treatment planning, as it is fast, inexpensive and readily available. Its main limitation, however, is the limited sensitivity in the hyperacute setting. Manifestation of CT features is a process lasting several hours, making evaluation of CT scans difficult. MR is currently only scarcely used in stroke imaging. 

STAIRS

The project STAIRS – Stroke treatment decision support by Artificial Intelligence for analysis of MR images – was established to investigate and develop novel AI techniques to accelerate MR imaging, and enhance its interpretation. Ten times accelerated MRI imaging and robust AI analysis will be developed and tested in the North-Holland, the Netherlands environment to demonstrate a short door-to-treatment time for patients. 

The consortium partners combine experience and expertise to lead the project and transform MR imaging in stroke. Amsterdam UMC, a world-leading stroke center, together with two other Dutch Academic Medical centers initiated and executed the renowned MR CLEAN trial that revolutionized stroke treatment and has extensive knowledge on stroke and MR imaging as such. Nico.lab successfully developed AI algorithms for CT imaging, and has a strong skill set in utilizing advanced AI to tackle medical imaging problems. Google Cloud Platform offers high-speed data access, as well as dedicated High Performance Computing resources, needed to enable MR image analysis by AI in the cloud. The company Qlouder aims at delivering cloud solutions to their partners.

Matthan Caan, assistant professor Amsterdam UMC: “The objective of STAIRS is improving AI-supported treatment planning of acute ischemic stroke based on MR imaging as an alternative to CT, enhancing efficiency of AI methods and exploiting hardware opportunities to its max. This AMC TKI-PPP subsidy allows us to take significant steps to improving decision-making in acute stroke”

 

Nico.Lab wins grant & approached to use StrokeViewer® in 3 clinical trials

By | News

In July, Nico.Lab won a grant from the European Union in excess of AUD 700,000. The funds received will be used to implement a project together with a Canadian partner, which received an additional amount AUD 450,000. With this subsidy, Nico.Lab will develop and test a new Artificial Intelligence algorithm to significantly enhance and speed up stroke treatment in North America.

Please read this article on Australia’s Wholesale Investor.

Nico.lab welcomes the new European General Data Protection Regulation (GDPR)

By | News

On May the 25th, the new General Data Protection Regulation (GDPR) comes into effect in the European Union. With the GDPR, the EU aims to protect the privacy and personal data of all citizens. The GDPR gives every individual primary control over his/her data, and holds all companies and organizations accountable for safe and legitimate processing of this data.

The GDPR has an important impact on the collection and processing of medical data. As a processor of sensitive medical data, Nico.lab welcomes and emphasizes compliance with the GDPR. Nico.lab incorporates security of StrokeViewer as one of its core values in the development of StrokeViewer, making StrokeViewer secure-by-design. Also, StrokeViewer only shows the necessary information for diagnostic purposes “by default”, and can be tailored per hospital. To ensure the utmost quality of our company Infomation Security Management System (ISMS), Nico.lab is supported by fore-front legal offices specialized in medical technology.

We are happy to answer any questions regarding privacy and security. Please send a message via our contact page. For further information regarding the GDPR, please read the information provided by the EU.