WEISS Annual Report 2019

Phantom development in the laboratories of Charles Bell House

ANNUAL REPORT 2019

Website: ucl.ac.uk/weiss Email: weiss-admin@ucl.ac.uk @WEISS_UCL

35899_WEISS ANNUAL REPORT_COVER_003.indd 1-2

05/12/2019 13:57

2

WEISS Annual Report

WEISS Annual Report 27

WELLCOME / EPSRC CENTRE FOR INTERVENTIONAL AND SURGICAL SCIENCES

JANUARY

MESSAGE FROM THE DIRECTOR We have had an incredible and action-packed year. Just for perspective, we have attracted over £23M in new funding, published over 100 papers and patents and created two new spin-outs.

While numbers do not reflect the full scope and impact of our efforts, they are indicative of the thriving research and translational environment that you underpin at WEISS!

PROFESSOR DAN STOYANOV

The Centre has grown dramatically in 2019 with six new academics recruited specifically in the WEISS remit, two new external fellowships and four new WEISS fellows. Clinical and engineering investigators are collaborating on over 20 ethically approved trials, investigating the feasibility of translating innovation into clinical benefits. This is nothing short of incredible and completely unique in the world landscape.

It was my great honour this year to take on the Director role at WEISS, somewhat dauntingly receiving the baton from Prof. Dave Hawkes, who tirelessly directed WEISS over the past two years and decided to take a well-earned reduction in commitments. Dave founded the Centre for Medical Image Computing (CMIC) in 2005 and

2020 DATES FOR YOUR DIARY! Thursday 2nd January – UCL re-opens after the Christmas break

pioneered activity in engineering for surgery and interventions at UCL which ultimately led to the creation of WEISS. He is a world authority in medical image computing and has been one of the early champions of the field of computerassisted interventions. We deeply thank Dave for his service and are fortunate that he will continue to be part of WEISS as a key advisor but meanwhile have the time to collect a host of deserved accolades that keep being awarded in recognition of his contributions to the field.

This year we also say goodbye to our WEISS Administrator, Kate Litwinczuk, who has been nothing short of the foundation of WEISS. We will miss Kate tremendously both professionally and personally. A sad impact of her absence will be a notable reduction in the Centre’s wit and humour.

We wish her well in her new adventures and career.

As ever, next year, we look forward to even more successes. Thank you all for your dedication to both the highest levels of research and to pushing for clinical translation and impact within WEISS. Dan

FEBRUARY

PROFESSOR LAURENCE LOVAT

The transition of Director from Dave Hawkes to Dan Stoyanov has, in my opinion, gone very

35899_WEISS ANNUAL REPORT_COVER_003.indd 2-27

smoothly. Dave set us up brilliantly and Dan is really developing the vision. It is my great privilege to be able to work with such great scientific leaders, supported by a strongly motivated central team led so ably by Su-Lin. I am really sorry that Kate is leaving, although she is going to indulge her passion for languages which, in fairness, is not something WEISS focuses on, notwithstanding the wonderfully cosmopolitan group of researchers that we have managed to attract to UCL. We wish Kate every success.

Looking forward to 2020, we will continue to encourage the very best interdisciplinary scientists and medical researchers to work together at WEISS so we can bring benefits to patients undergoing surgery and other medical interventions in the UK and throughout the world.

Laurence

WEISS submits annual report to funders 1st - 6th February SPIE Photonics West Conference 15th - 20th February SPIE Medical Imaging Conference

MARCH

Tuesday 3rd March – MICCAI deadline WEISS Research Management Group meeting WEISS Clinical Steering Committee meeting QMS Management Review meeting

APRIL

3rd - 7th April, ISBI Conference Tuesday 7th April – WEISS Science of Surgery, Public Engagement Event April - Review and renewal of WEISS Research Platforms

MAY

31st May – 4th June ICRA Conference Public Engagement Advisory Board meeting

JUNE

All WEISS Co-Investigators meeting QMS Management Review Meeting 13th - 19th June, CVPR Conference

MESSAGE FROM THE CLINICAL DIRECTOR The last year has been inspirational at WEISS. Clinical engagement continues to grow. We have more clinical teams coming forward with new ideas.

These are both new problems for which they are seeking engineering and computer science support and also responses to the engineering platforms that are already available. The grant funding is coming in thick and fast and Charles Bell House, which was quite empty at the beginning of the year is now brimming full with people. They in turn bring their energies and enthusiasm to meet the most taxing med-tech challenges of our era. I am excited that we have launched two clinical funding calls – the WEISS Health Challenge 2020 and the WEISS Senior Clinical Fellowships 2020. We look forward to awarding these in the New Year.

WEISS Call for Clinical Training Fellows

15th - 18th June, BSG Conference 21st - 24th June, Hamlyn Symposium 23rd - 27th June, CARS Conference 23rd - 24th June, IPCAI Conference

JULY

7th - 9th July, WEISS Project-focused Retreat for staff and students

AUGUST

WEISS Research Management Group meeting WEISS Clinical Steering Committee meeting QMS Management Review meeting

SEPTEMBER

7th - 8th September – WEISS International Advisory Board meeting

OCTOBER

4th - 8th October, MICCAI Conference 24th - 30th October, IROS Conference

05/12/2019 13:57

WEISS Annual Report 3

MESSAGE FROM PROFESSOR DAVID HAWKES, FORMER INTERIM DIRECTOR OF WEISS It has been an exciting two years at WEISS! The Centre represents the cumulation of many years of hard work from all our Investigators building our vision of innovation in engineering, physics and computing, translating into real impact on patient health in interventional and surgical sciences. When I took over as Interim Director in April 2018 the Centre was at high risk due to the departure of the then Director and his team, but everyone put in an amazing effort to make our vision a reality and in the very short time to September 2018 the Centre successfully underwent international review, re-establishing our momentum. In June this year we appointed Dan Stoyanov as our new Director, and in July we welcomed Su-Lin Lee as new our Head of Operations. We are now busy recruiting 3 new academic positions and 2 WEISS Fellows, each of whom will build their own vibrant research and translational activity. We have nurtured 3 start-up companies (SmartTarget, Echopoint and Odin) and have raised significant external resource to ensure our Centre is sustainable. With the Centre for Medical Image Computing (CMIC), we have set up a thriving Centre for Doctoral Training to create the next generation of engineers working in this exciting area.

Our Centre has been created at an exciting time for engineering applied to surgical and interventional sciences. Surgical robotics, having had a challenging gestation, is now mainstream and the next generation of surgical robotics are poised to have significant impact across a wide range of surgical and interventional applications; novel sensors, including embedded nano-devices, are being developed to revolutionise the way interventions and implanted devices are actively monitored; surgical data analytics, powered by the latest advances in AI, are revolutionising the way we deliver novel treatments, measure efficacy of interventions, assess surgical performance and raise the quality of surgical training. WEISS is internationally leading in all these areas.

I wish to thank everyone for their strong support over the last 2 years but in particular the Dean of Engineering, Nigel TitchenerHooker, the Dean of Medicine, Mark Emberton, and the Vice Provost of Research David Price for their strong institutional support and all members of the Delivery Team for working together so effectively, in particular in the run up to the review in September 2018. A very special thanks to Anne Mathiot, who as Centre Manager supported me in the difficult transition until her departure for Canada in July 2018, and the amazing Kate Litwinczuk, who acted up as Centre Manager for the 12 months until Su-Lin Lee was appointed. Without the superb support of these two we would not have a Centre now. My gratitude to Dan Stoyanov for stepping up so effectively to Centre Director, and showing real leadership taking WEISS forward since his appointment in July. Su-Lin Lee has taken charge very effectively as Head of Operations. Above all I want to thank all the current members of WEISS: engineers, clinicians, students and support staff who have built a formidable Centre with a very exciting future ahead. WEISS is in really good shape, and I’m proud to have been Interim Director at this transformative time.

35899_WEISS ANNUAL REPORT_0011.indd 3

CONTENTS 2 5 6 8

10

WELLCOME / EPSRC CENTRE FOR INTERVENTIONAL AND SURGICAL SCIENCES PROFESSIONAL SUPPORT AT WEISS WEISS IN THE NEWS

INCUBATING SPIN-OUTS AT WEISS SPOTLIGHT ON...

COLLABORATION

12

PUBLIC ENGAGEMENT AND PATIENT INVOLVEMENT AT WEISS

15

WEISS INTERNATIONAL ADVISORY BOARD

16 18

WEISS REPORT SPOTLIGHT WEISS REPORT SPOTLIGHT

20

CASE STUDY: ADVANCED MINIATURE SENSORS FOR SAFER BIRTH

22

WEISS REPORT SPOTLIGHT

24

26 27

WEISS STAFF AND STUDENTS ON THE MOVE SOCIAL AT WEISS

2020 DATES FOR YOUR DIARY!

06/12/2019 16:53

Phantom development in the laboratories at Charles Bell House

35899_WEISS ANNUAL REPORT_0011.indd 4

06/12/2019 16:53

WEISS Annual Report 5

PROFESSIONAL SUPPORT AT WEISS We are very lucky at WEISS to host a great Professional Services team, with specialist support for Public Engagement, Clinical Trials, and Quality Management – as well as expert operational support. Here are just two examples of the expertise available to WEISS members:

QUALITY MANAGEMENT SYSTEMS WEISS hosts a fully certified Quality Management System (QMS), and this framework is in place to support the development of medical software and software-based interventional systems to CE marking and FDA approval.

The QMS currently supports three projects, including: nnSoftware for guiding prostate biopsy and minimally-invasive surgical interventions. nnSoftware for intra-operative planning of laparoscopic liver surgery. nnSoftware for planning non-invasive, therapeutic ultrasound treatments for brain diseases.

In each case, the aim is to develop a product that complies with ISO-13485 (international standard for medical devices) to satisfy the EU/US medical device regulations and help accelerate commercialisation and clinical translation.

Sarina Hussain is the Quality Manager and manages the ISO13485-certified QMS . She takes the lead in the implementation of new quality processes and provides support for a range of medical device development projects. A key aspect of Sarina’s role is to ensure regulatory compliance of the QMS and projects that run within it, and to facilitate best practice in technology design, development and evaluation

35899_WEISS ANNUAL REPORT_0011.indd 5

CLINICAL TRIALS SUPPORT The innovative surgical technologies being developed at WEISS are supported by a clear translational strategy of improving patient care and health outcomes through more precise, less invasive and safer procedures. A key aim of the centre therefore is to demonstrate clinical impact through clinical trials.

The current portfolio includes over 23 clinical trials and studies, which aim to evaluate the feasibility, clinical safety and/or clinical performance of new surgical technologies in the clinical setting.

Jennifer Child joined WEISS as Senior Trial Coordinator in August 2019. Her role is to support WEISS co-investigators in the set-up and running of high-quality clinical trials.

Jennifer works closely alongside the clinical and engineering teams to ensure that the clinical trials undertaken, or supported by WEISS are appropriately developed, sponsored, and run; and in compliance with all applicable ethical, regulatory and Sponsor requirements.

06/12/2019 16:53

6

WEISS Annual Report

WEISS IN THE NEWS WEISS DIRECTOR ANNOUNCED ROYAL ACADEMY OF ENGINEERING CHAIR IN EMERGING TECHNOLOGIES

P

rof Danail Stoyanov, Director of Wellcome / EPSRC Centre for Interventional and Surgical Sciences (WEISS) will develop robotic actuated imaging skins. He is one of eight new Chairs in Emerging Technologies, through which the Royal Academy of Engineering have awarded £22m total.

Prof Stoyanov will develop robotic surface structures with embedded sensors that can adapt their shape and size using artificial intelligence algorithms to control and interpret sensory information. Using this date, his new systems will help to enhance imaging capabilities during minimally invasive surgery and enable safer and more precise procedures to treat diseases across different anatomical regions.

This research sits alongside intelligent and resilient ocean engineering, new kinds of batteries and more precise x-ray scans as examples of disruptive innovations being developed by the Royal Academy of Engineering’s latest Chairs in Emerging Technologies.

The innovations being developed by the Chairs in Emerging Technologies have the potential to considerably benefit society and the UK economy, and enable the nation to remain at the global forefront of engineering

35899_WEISS ANNUAL REPORT_0011.indd 6

innovation. The areas of research funded reflect the UK’s wider technological priorities, with many of the projects directly aligned to the government’s Industrial Strategy and designed to tackle some of the biggest industrial and societal challenges of our time.

With awards totalling over £22million, the ten-year support provided to the Chairs will enable them to progress their pioneering ideas from basic science through to full deployment and commercialisation.

I

t is a great honour to receive the support of The Royal Academy of Engineering once again. This ambitious research programme will enable us to develop an entirely new way of seeing important information during surgery.”

PROF DANAIL STOYANOV

- Prof Stoyanov

06/12/2019 16:53

WEISS Annual Report 7

ECHOPOINT RAISES £2.8M TO ADDRESS THE ‘GREY ZONE’ OF HEART DISEASE TREATMENT

E

chopoint Medical Ltd, a spinout company from UCL, has raised £2.8m to develop optical sensing technology to help heart disease patients in a grey zone where the need for treatment is unclear.

As featured in The Telegraph, Echopoint Medical Ltd, a spinout company from UCL, has raised £2.8m to develop optical sensing technology to help heart disease patients in a ‘grey zone’ where the need for treatment is unclear.

This technology could speed up diagnosis for tens of thousands of NHS patients a year.

Coronary heart disease is a major cause of death worldwide and more than 7 million people have a diagnosis in the UK alone. Narrowing arteries caused by the disease are commonly treated by the insertion of tiny tubes called stents, but the process is both risky and expensive.

Echopoint has raised its investment from the UCL Technology Fund, Parkwalk and two grants from Innovate UK. It will use the funding to further develop the optical fibre sensors on its microcatheters, as well as its unique technology platform which translates their ultrasound signals into meaningful metrics. The company will also complete a 20-30 patient clinical trial.

Echopoint was founded in November 2018 and is led by executive chairman Antony Odell, an experienced medtech entrepreneur and previous CEO of Tissue Regenix; Dr Adrien Desjardins, Chief Technical Officer and a senior lecturer in the Department of Medical Physics and Biomedical Engineering at UCL; and Dr Malcolm Finlay, Chief Medical Officer and a consultant cardiologist at Barts Heart Centre. The start-up is being incubated within the Wellcome / EPSRC Centre for Interventional and Surgical Sciences at UCL and is a UCL Business spin-out company.

Current methods for determining whether to place a stent are inadequate. Dye-based imaging techniques deliver inconclusive results on the need for a stent for a large ‘grey zone’ of patients, many of whom undergo unnecessary invasive surgery as a result.

Echopoint has developed inexpensive microcatheters which use fibre-optic sensors to accurately measure blood pressure and flow, enabling clinicians to precisely assess patients and dramatically reduce stent implants.

35899_WEISS ANNUAL REPORT_0011.indd 7

ANTONY ODELL – EXECUTIVE CHAIRMAN

PROF ADRIEN DESJARDINS

06/12/2019 16:53

8

WEISS Annual Report

INCUBATING SPIN-OUTS AT WEISS WEISS has a vision to have a significant impact on the NHS and healthcare globally. The main goals of WEISS are to enable the transformation of clinical translation of engineering innovations in the fields of interventional and surgical sciences, enabling a dramatic speed up in the technology transfer from lab to entering first clinical trial.

To achieve these goals, WEISS has created a shared space for surgeons, imaging scientists, and engineers and joint infrastructure across UCL disciplines at Charles Bell House. A dedicated incubator space has been created on the first floor which is designed to nurture innovation and growth for UCL spin-outs in the interventional and surgical sciences. In addition to collocation with academic partners, the spin-outs gain access to excellent facilities and full WEISS support.

ODIN VISION 2019 has been an exciting year for Odin Vision. The company was founded to commercialize artificial intelligence (AI) technology, developed at WEISS, to improve the detection and diagnosis of cancer in gastroenterology. Odin spun out the technology through UCLB’s Portico Programme with investment from the

UCL Tech fund and went on to win grants from Innovate UK, the European Space Agency, The Royal Society and The Royal Academy of Engineering. They were awarded places on the P4 Precision Medicine accelerator and the EEN Innovate to Succeed programme. Odin was named as one of the UK’s top early-stage AI startups by market intelligence company Beauhurst and their technology featured on the BBC and Reuters.

Each year, 150 million endoscopy procedures are performed. Doctors use endoscopy to identify, diagnose and treat diseases of the digestive system such as colorectal and esophageal cancer. However, interpreting endoscopic images is very challenging, doctors miss over 25% of colorectal polyps and experts can disagree on diagnosis. Odin is developing a suite of applications for automatically interpreting endoscopy images to improve the detection and diagnosis of diseases.

Gastroenterology is at a watershed moment. AI has the potential to disrupt current practices through a new generation of tools that support doctors in their decision making. Looking forward to next year, Odin will be taking their technology through clinical trials, expanding their research effort and increasing the range of clinical applications.

35899_WEISS ANNUAL REPORT_0011.indd 8

06/12/2019 16:53

WEISS Annual Report 9

ECHOPOINT MEDICAL LTD “The iKOr precision optical sensor platform: Transforming cathlab decision making and patient outcomes” EML is a UCLB spinout which is commercialising a UCL developed platform technology called iKOr which has three main application areas:

SENSING

IMAGING

TRACKING

PRESSURE and FLOW in single sensor.

All-optical ultrasound.

Easy to use & Fits clinical workflow.

Immune to EM interference.

Low cost manufacturing.

POC established.

Published trans-septal in-vivo study

The first product - the iKOs Microcatheter will enable improved real-time diagnostic feedback of flow during interventional cardiac procedures.

EML is responding to a clinical need – to significantly improve how blood flow in the heart is measured.

In interventional cardiology today, flow is usually measured indirectly with intravascular pressure measurements across a stenotic region. Direct measurements of flow would be transformative, with strong potential to shed light on coronary microvascular dysfunction and improve decision making about stenting and other therapies.

The iKOs Microcatheter will allow for rapid and robust measurements of flow-based parameters that are already familiar to the cardiovascular community, such as coronary flow reserve and the index of microcirculatory resistance. The microcatheter has novel, highly miniature fiber optic sensing components that provide both pressure and temperature measurements. No injections of saline are required and the microcatheter is fully compatible with clinical practice.

A BUSY YEAR… 2019 has been pivotal for EML with the closure of our seed funding round supported by UCLTF and Parkwalk Advisors which coupled with the award of two Innovate grants gives us enough firepower to get to a first in human study in 2021. Additionally we have begun building a strong industry-experienced team to drive this programme forward, Shiva Golchi and Laura Lagonigro both have extensive experience in their fields.

REACHING OUT… EML has also started building strong relationships with leading interventional cardiology companies and clinical key opinion leaders in Europe and the US to ensure that the final product meets/exceeds expectations and enables the key goal of improving patient outcomes.

35899_WEISS ANNUAL REPORT_0011.indd 9

Needle tip tracking in real time.

Successful in-vivo study

PATIENT NEEDS ARE KEY...

Patients are a vital part of our development mix and we are working with patient user groups to understand precisely what concerns they have with current practice and ensure these can be addressed.

Lack of diagnosis leads to patient uncertainty and accentuates the stress of these already difficult situations.

LOOKING FORWARD… The team at WEISS has been very supportive as we have grown within the structure and will continue to be important as we expand, our ongoing presence in Charles Bell House and the facilities and opportunities it provides will be key for the foreseeable future.

06/12/2019 16:53

10

WEISS Annual Report

SPOTLIGHT ON...

COLLABORATION: Hani Marcus and Manios Dimitrakakis

BRAIN SURGERY WITH ROBOTICS, ARTIFICIAL INTELLIGENCE, AND NEURONAVIGATION (BRAIN) The pituitary is a tiny gland, the size of a pea, which lies deep within the base of the brain. It acts as the “master gland” of the body and stimulates other glands to produce hormones. Tumours within the pituitary gland are usually treated with surgery, which is typically done through the nose using the so-called “transsphenoidal” approach. The transsphenoidal approach is one of the best examples of keyhole surgery in the brain and results in fewer complications and more rapid recovery than conventional open surgery through the skull.

Over the past decade endoscopes have allowed some surgeons to extend the use of the transsphenoidal approach to include pituitary tumours that have invaded surrounding tissues, and other tumours around the base of the brain. These tumours have been difficult or impossible to reach in the past, and almost always required open surgery. Although there are obvious theoretical benefits to such tumours now being treated with keyhole surgery, most surgeons still find operating in this way very difficult. In a recent study of members of the Society of British Neurological Surgeons, we asked surgeons the reasons for this and the majority reported that they struggled with lack of 3D vision with existing cameras and found using existing instruments akin to “operating using chopsticks”. In other words, surgeons found it difficult to see where things were clearly, and difficult to handle tissue carefully.

In the coming years, we aim to address these barriers by working with engineers to adapt existing devices, and develop new ones, tailored to the particular requirements of this approach. The objectives are threefold:

35899_WEISS ANNUAL REPORT_0011.indd 10

First, we want to combine augmented reality and a specially designed 3D camera to enhance the surgeon’s vision. Working through the nostril the surgeon relies on a live video feed rather than direct vision. Augmented reality will provide the surgeon with information about where important things are, particularly when they are hidden from view, and place on top of the video feed. Similarly, the 3D camera will allow the surgeon to better appreciate depth.

Second, we want to introduce robotic instruments that allow for wrist-like dexterity, and limit the forces exerted, to enhance the surgeon’s touch. Using small tendons and force sensors will allow the instruments to bend within spaces far smaller than a surgeon’s hands, and to detect forces far lower than can be perceived by a surgeon’s fingers.

Finally, we want to use artificial intelligence developed using videos of existing experts to enhance the surgeon’s judgement when deciding, for example, the balance between wanting to resect as much tumour as possible, while still preserving normal pituitary gland.

Our hope is that these new devices will work together synergistically to make pituitary surgery safer and more effective, particularly in challenging situations where the tumour has invaded surrounding tissues. In the future, our devices may also allow surgeons to operate through the nose in cases where they may currently have to resort to surgery through the skull, therefore allowing more patients to enjoy the benefits of keyhole surgery.

06/12/2019 16:53

WEISS Annual Report 11

MR HANI J MARCUS

I

have recently been appointed as an academic consultant neurosurgeon and consider myself incredibly fortunate. I currently spend half my time spent at the National Hospital for Neurology and Neurosurgery where my clinical interest is in “keyhole” brain surgery, and the other half at WEISS where I help develop instruments to make this surgery safer and more effective.

Working with talented engineers such as Manios is a real privilege, and provides unparalleled opportunities for seeing these instruments make their way from the laboratory to the operating theatre.”

- Mr Hani J Marcus, PhD FRCS, WEISS Clinical Co-Investigator, Consultant Neurosurgeon

35899_WEISS ANNUAL REPORT_0011.indd 11

MANIOS (EMMANOUIL) DIMITRAKAKIS

A

n engineer’s main task, whether it’s in research or industry, is always to solve a problem. While trying to contribute in your field, it is often that you will find yourself out of ideas or preoccupied with techniques and solutions proven not to work. Especially in fields like robotic surgery, where a deep understanding of surgical complications and practices is essential. That is why I’m vastly grateful for being given the opportunity to conduct my PhD within WEISS, and especially for working closely with Hani. Doing a PhD is no easy task, but it sure gets easier when you’re driven by the fact that your work could actually make a real difference in patient’s lives.”

- Manios (Emmanouil) Dimitrakakis, WEISS PhD Student and Research Assistant

06/12/2019 16:53

12

WEISS Annual Report

PUBLIC ENGAGEMENT AND PATIENT INVOLVEMENT Public engagement is a key part of our work as a Centre, involving the public in ways that explore and shape our research, with the aim to develop research innovation with public and patient impact at its heart.

This is embedded throughout our work as a Centre, featured as one of our three aims, in our translational strategy and with a dedicated Public Engagement Manager.

It is threaded throughout Centre processes, in job descriptions, internal funding calls and reporting, and with representation at senior level.

DANIEL TAYLOR, PUBLIC ENGAGEMENT MANAGER

Over the last twelve months the Centre has reached over 1,500 members of the public, through a range of activities to explore research with the public, shape our work and collaboratively develop ideas together.

This ranges from patient advisory groups to hosting and participating in large scale public events.

Our public engagement has featured over WEISS seventy members in 2019. They are supported in this through 1-1 advice, training and professional support, including training on topics from public and patient involvement and how we talk about data use, to developing interactive activities and artist collaborations.

As well as supporting members to do public engagement we try to find ways of recognizing their work, with ten leads for this year’s WEISS Science of Surgery public open day presented with Director’s letters of appreciation, members submitted for the UCL Provost’s Public Engagement Awards (to be announced in 2020) and awards for practice included in centre events.

All our work is underpinned by a dedicated public engagement strategy, developed after consultation across the centre and ratified by a Public Engagement Advisory Board featuring the WEISS executive team,

35899_WEISS ANNUAL REPORT_0011.indd 12

T

o engage with publics to improve the design and translation of WEISS research, building public awareness by opening up conversations about the implications for people’s lives.”

WEISS Public Engagement Vision

internal members, a patient representative and chaired by Mary-Clare Hallsworth, Head of Public Engagement at Birkbeck University of London.

This lays out our key publics and the attributes expected of public engagement activities, those being to use engagement to enhance the development, translation and impact of research; collaborate with relevant publics and external partners; develop the skills of our members and embed practice in research and the centre.

06/12/2019 16:53

WEISS Annual Report 13

SCIENCE OF SURGERY On Friday 12 April 2019 the Centre welcomed 300 members of the public to visit our offices at Charles Bell House for ‘Science of Surgery’ a public open day targeted at families in our local borough of Camden.

The event aimed to raise local awareness of research, develop members’ skills and opportunity for public engagement and to build relationships with local charities and organisations.

Science of Surgery featured seventeen interactive stations exploring how research at the Centre is contributing to modern surgery, ranging from magic tricks demonstrating medical data, to give-it-a-go mock robotic surgery and using paints to replicate cell samples.

Almost 50% of our visitors came from Camden and neighbouring boroughs, with overwhelmingly positive feedback. 94% said they would definitely come again, and qualitative feedback focused on the fun and interactive nature of activities, the quality and enthusiasm of our members and the content’s direct relevance to practice.

I

enjoyed everything! It was very interesting to learn about the various research areas, new equipment and the people working to improve our health and so many areas!”

Over fifty members of WEISS were involved in the event across specialties and seniority, taking part in activity development, delivery and event support. Individual project teams were managed by ten public engagement leads, given advice, peer support and training to develop skills in public engagement and project management.

W

e didn’t only inspire the children, but I think they also inspired us and gave us motivation and positive energy to do our research. Thank you so much for organising this event! I will definitely join the team again next year.”

The event gave the opportunity to reach out to local community organisations, charities and schools, with the Public Engagement Manager making face-to-face contact with five organisations for the first time, from which activity and conversations are continuing since.

We are now starting preparations for the next event in 2020, building on activities to develop new ideas and incorporate connections, ideas and initiatives that have developed since.

35899_WEISS ANNUAL REPORT_0011.indd 13

2019 HIGHLIGHTS nn In March we held a celebratory evaluation event for a long running patient involvement group led by Professor Anna David, recognising members and developing next steps. nn Science of Surgery took place in April, featuring interactive activities for over 300 members of the public on site across all major research areas at WEISS. nn Outreach activities are also an important part of our work at the centre, in July Daniil Nikitichev was involved in a robotics project at an Academy in Hackney, culminating in an all-day science festival. nn Patient and Public Involvement is being embedded from the very start of a new Operative Birth group, co-developing this with parents and charities.

The first parent meeting took place in October. nn In November members were involved in the Centre for Nerve Engineering Nerve Injury Community Day, organised and delivered by and for people both working and living with nerve injury. nn We have delivered a wide range of training, such as Introduction to Patient and Public Involvement in February and March, and Artist-led workshops in December, both with follow-on funding rounds.

06/12/2019 16:53

35899_WEISS ANNUAL REPORT_0011.indd 14

06/12/2019 16:53

WEISS Annual Report 15

WEISS INTERNATIONAL ADVISORY BOARD

I

n September this year, we held our first WEISS International Advisory Board (IAB) meeting. Our IAB members are experts in the fields of interventional and surgical sciences from both academia and industry and they were joined at this meeting by representatives from both the Wellcome Trust and the EPSRC. The two-day event included presentations about WEISS and highlights of some of our research platforms, demonstrations and posters of our research, and social activities for our researchers to interact more with members of our IAB. Feedback from our IAB members was very positive and has been feeding into the WEISS strategy for the next year. Next year’s IAB meeting has already been scheduled for 7-8 September 2020.

35899_WEISS ANNUAL REPORT_0011.indd 15

WEISS INTERNATIONAL ADVISORY BOARD MEMBERS 2019 nn Simon DiMaio, Intuitive Surgical nn Peter McCulloch, University of Oxford nn Nassir Navab, Technical University of Munich nn David Noonan, Auris Health nn Carla Pugh, Stanford University nn Sebastian Schostek, Ovesco Endoscopy nn Russell Taylor, Johns Hopkins University nn David Tuch, Lightpoint Medical

06/12/2019 16:53

16

WEISS Annual Report

WEISS REPORT SPOTLIGHT Vanessa Diaz

TACKLING AORTIC DISSECTIONS AND ADDRESSING GLOBAL INEQUALITIES THROUGH STATE OF THE ART ENGINEERING SOLUTIONS Here in the WEISS centre we are developing exciting and world-leading work around the use of state of the art CFD and in vitro tools to assess patients’ individual risk in clinically compatible timescales and to engineer optimised, tailored treatment for each individual patient. Our Engineering team at WEISS has teamed up with colleagues in the Vascular service at the Royal Free Hospital and is currently partnering with the team led by Dr. Rui Loureiro at the Royal National Orthopaedic Hospital in Stanmore to produce research that will impact patients’ lives.

What is an Aortic Dissection? An Aortic Dissection involves a tear in the aorta, the body’s largest artery, which carries blood from the heart to the brain, limbs and vital organs. A surprising statistic is that Aortic Dissections, although considered rare, kill more people in the UK than road traffic accidents.

Aortic Dissections affect about 4,000 people a year in the UK, but only 1,200 of them will survive and be admitted to hospital1. Even then, mortality risk remains high, with a lethality rate of 1 to 2% per hour after onset of symptoms in untreated patients. Prompt and proper diagnosis is vital to increase a patient’s chance of survival and to prevent further complications.

A Dissected Aorta is weaker and unique: no two patients are alike and the dissection can involve the main aorta and a number of aortic branches or inclusive, organs. This makes interventions on these patients extremely challenging for vascular or cardiothoracic teams as each patient is definitely one of a kind and the best treatment option, patient-specific.

1

Type-B Aortic Dissection (AD) is a complex vascular condition at the heart of our research

A GLOBAL PROBLEM THAT REQUIRES GLOBAL PARTNERS TO ADDRESS GLOBAL HEALTH INEQUALITIES Aortic Dissections are a huge concern in China (and South East Asia in general) where the incidence of the condition is higher, and it presents itself in younger groups (around 40 years of age), whilst the UK or Europe this a condition that appears in groups of patients > 65 years old and the reasons for these discrepancies are unclear. This is why, in order to develop a comprehensive and internationally leading programme of research with global impact, we need international partnerships to address the many challenges posed by ethnicity, environmental factors and access to healthcare resources if we are serious about leading from the front. There are excellent Centres in South East Asia performing extraordinary research to advance the understanding of the condition and to develop individualised treatment for patients and the WEISS vascular team is making an effort to establish key international partnerships including China, Singapore, the US and of course, the UK.

https://scts.org/aortic-dissection-kills-more-people-in-the-uk-than-road-traffic-accidents/

35899_WEISS ANNUAL REPORT_0011.indd 16

06/12/2019 16:53

WEISS Annual Report 17

OUR PLATFORM FOR PRECISION VASCULAR MEDICINE We have developed an exciting programme of work based on a platform for precision vascular medicine able to analyse complex vascular pathologies, including Aortic Dissection cases. Understanding the blood flow dynamics and the role of other haemodynamic markers in AD disease progression and prognosis of the surgical interventions involved in this complex pathology is extremely difficult and, in many cases, completely counterintuitive.

A combined in vivo, in silico, in vitro approach to emulate the haemodynamics of individual patients

A TYPICAL CLINICAL PATHWAY The current clinical pathway/treatment for uncomplicated Type-B AD is best medical therapy (BMT). However, some patients managed with BMT may later develop complications such as aneurysmal dilatation. Early interventions, including stenting and surgery may reduce the risk of aneurysmal dilatation but are associated with significant morbidity and even mortality.

At present, it is impossible to predict which group of patients will develop complications, hence requiring early intervention including stenting or surgery. If we can help test best Workflow. The ‘star’ sign indicates where our surgical strategies platform will be used. We will provide doctor/ patient communication tools via interactive and use our technology (step 3) to discuss treatment. platform to improve Another point of intervention will be in step doctor/patient 4, where different surgical strategies will be tested virtually, simulations performed and a communication and ‘best’ strategy tested in-vitro in the physical education, we will be testing section. All this must be ready in clinically meaningful timescales. making an impact.

The potential benefits of such platform are vast, including: nn Assisting with decision-making by improving the prediction of treatment outcome/ prognosis for AD and other vascular conditions in the near future.

RESEARCH HIGHLIGHTS

nn Enabling clinicians to plan and test interventional options by virtually performing them on the platform prior to performing the actual intervention, to optimise outcome and reduce risk of complication or even unnecessary operation.

nn Our work is being increasingly recognised as worldleading in the use of engineering tools for Aortic Dissection assessment and treatment

nn Allowing the patients to “visualise” their own vascular pathology, interventional treatment options, and potential outcomes (both benefits and risks) in a simulated model, hence improving their decision making, doctor-patient communication and informed consent process. nn Providing a training platform for less experienced operators, particularly for complex AD procedures.

The Vascular Unit at Royal Free Hospital (RFH) is a tertiary and high-volume centre for this condition, with an experienced and world-class clinical team, providing a rich set of clinical data, expertise, and patient groups hence, serving as testing bed for our platform.

nn We have currently a unique in vitro/in silico platform to test personalised interventions in Aortic Dissection cases nn We have produced state of the art CFD simulations that provide insight into the condition nn We can predict in a reliable and confident way pressures and flows in regions where these cannot be or are too risky to be measured, namely, the false lumen nn We can check that perfusion to key organs is maintained nn We are currently working on Virtual reality and Augmented Reality tools to be used on our platform as preinterventional tools to optimise patient-specific treatment nn We are currently working with the main Aortic Dissection charity in the UK to raise awareness of the condition nn We are making key connections in other UK Hospitals and UK Government in order to translate our tools to the clinic nn We are currently building an international network of collaborators and developing a joint strategic research agenda with Prof. Duanduan Chen at the Beijing Institute of Technology

35899_WEISS ANNUAL REPORT_0011.indd 17

06/12/2019 16:53

18

WEISS Annual Report

SPOTLIGHT REPORT

Non invasive clinical photoacoustic imaging: the first steps Paul Beard, Andrew Plumb, Nam Huynh, Olivia Francies, Katerina Soteriou 2019 has been a fruitful year with the realisation of a prototype clinical photoacoustic scanner and the first patient studies undertaken to explore its applicability to the assessment of inflammatory arthritis and peripheral vascular disease. These clinical studies represent something of a landmark. Although photoacoustic imaging is reasonably well established as a small animal preclinical research tool, its clinical potential is relatively unexplored with few patient studies undertaken to date. This is perhaps surprising given its advantages which derive from the synergistic interaction of light and sound in tissue. In photoacoustic imaging, short pulses of laser light at near infrared wavelengths are incident on the skin. In this part of the electromagnetic spectrum, light penetrates relatively deeply and is strongly scattered in tissue resulting in a large (cm³ scale) tissue volume being bathed in diffuse light. Absorption of the light by blood vessels and other subsurface structures results in a small temperature rise (0.1°C) and the subsequent emission of ultrasonic waves. By recording the time-of-arrival of these waves using an array of ultrasound receivers placed on the skin, an image can be reconstructed in much the same way as a conventional medical ultrasound image. Unlike conventional ultrasound however, image contrast is defined by the extent to which light is absorbed in tissue. Due to the strong optical absorption exhibited by haemoglobin, this makes photoacoustic imaging particularly well suited to visualising small blood vessels which might otherwise be invisible on a conventional ultrasound image. It thus lends itself to visualising tumours and other pathologies characterised by microvascular abnormalities with potential clinical applications in cancer, diabetes, cardiovascular disease and inflammatory conditions. Since establishing a translational research programme under the auspices of WEISS in 2017, with additional funding from CRUK, EPSRC, ERC and the NIHR, our aim has been to explore some of these applications.

35899_WEISS ANNUAL REPORT_0011.indd 18

06/12/2019 16:53

WEISS Annual Report 19

Building on over a decade of research in the lab, our first prototype non invasive clinical photoacoustic scanner (developed by Nam Huynh and Edward Zhang) finally came to fruition early this year; the critical technical challenges being to achieve sufficiently high frame rates for clinical use, a suitably versatile probe head for accessing different parts of the body and a degree of portability. Exploratory clinical studies led by UCLH radiologists Andrew Plumb and Olivia Francies were then established to investigate the utility of the scanner for assessing rheumatoid arthritis, head and neck cancers and peripheral vascular disease. A total of 25 patients have been scanned to date. Patients with inflammatory arthritis form the largest cohort to date and initial indications appear promising. By quantifying the photoacoustic image contrast in the synovial membrane where inflammation and increased vascularisation are hallmarks of arthritis, it has been shown that it may be possible to not only distinguish between joints with and without inflammation but also

to grade their severity. The next step is to increase the sample size and diversity, correlate images with additional clinical indicators and assess therapeutic response for treatment planning. Patients with diabetes have also been scanned revealing previously unseen irregular vascular patterns characterised by tortuous vessels, venous insufficiency and other microcirculatory abnormalities. Clinical relevance at this early stage remains to be established but, at the very least, these early results suggest the technology could be useful for studying the microcirculation in diabetes research.

Overall then, 2019 has been a productive year with the realisation of a practical scanner, the first patient results and the formation of a spin-out venture to commercialise the technology. As ever, there is much more to be done, not only to assess clinical value and explore new applications, but to refine the system optoelectronic hardware, develop new imaging probes and improve image interpretation and quantification.

Prototype clinical photoacoustic scanner (left), imaging probe (top right) and photoacoustic image of the vasculature in the index finger; image area 14mm x 14mm.

35899_WEISS ANNUAL REPORT_0011.indd 19

06/12/2019 16:53

20

WEISS Annual Report

CASE STUDY:

Advanced miniature sensors for safer birth CLINICAL NEED Obstetric surgery (Caesarean section, instrumental delivery and perineal repair) are the most common interventions globally yet there have been no new developments since the 1970s when Ventouse suction cups were developed. Factors such as rising maternal age, fertility techniques, and more liberal use of Caesarean delivery have rendered obstetrics to now be an acute surgical specialty. Over a third of UK women deliver by Caesarean Section (>50% emergency); another one-fifth have an instrumental vaginal delivery with associated perineal repair. There is little research on improving acute obstetric surgical care for the mother and fetus particularly in engineering, medical

physics and imaging. Interventions rely on digital vaginal examination and assessment of fetal head position, cervical dilatation and advancement of the fetal head through the pelvis during birth. External ultrasound imaging is suboptimal due to the position of the pelvis and symphysis pubis. The NHS Litigation Authority (NHSLA) spends >ÂŁ1 billion on clinical negligence claims nearly every year, of which 40% (almost ÂŁ0.5 billion) is for obstetric claims, mainly paid to braindamage in children as a result of complications during labour and delivery. Clearly there is an urgent need to develop miniature, safely deployable sensors.

WEISS TEAM ANNA DAVID

SAJA AABITH

DIMITRIOS SIASSAKOS

QICHAO REN

BISWAJOY BAGCHI

ADRIEN DESJARDINS

CHING-MEI CHEN

MANISH K. TIWARI

RICHARD CAULFIELD

35899_WEISS ANNUAL REPORT_0011.indd 20

06/12/2019 16:53

WEISS Annual Report 21

ENGINEERING SOLUTIONS: MINIATURE, WIRELESS SENSORS Tactile pressure sensing, which are generated by mechanical interaction between human touch and objects, include vibrations applied on the contact skin area and vibration propagated on remote skin area.

Measurement of such skin vibrations are important for the evaluation and analysis of the contact material’s textures and individual tactile sensations. Design of materials and tactile displays based on human body motion and skin vibrations provides reasonable and

effective tools for smart medical devices and surgical intervention procedures. To address the above laid out clinical challenges we are using our unique advanced materials and manufacturing capabilities to design new generation of highly miniaturised sensors. In particular, we are using our high-resolution (<1 Âľm precise) 3D printing technique to rapidly prototype a range of sensors, which enable tactile sensing as well as a number of physiological parameter monitoring capabilities.

Bespoke high-resolution 3D printing system based in WEISS Nanoengineering laboratories

A) Flexible interconnects printed on elastomeric substrates, demonstrating tight bendability feature. B) A multichannel PCB designed to facilitate easy, wireless connectivity to hand-held devices such as smartphones or secure servers for timely/early clinical interventions.

To provide a holistic solution strategy, we are using the high-resolution printing to develop a series of flexible electronics prototypes/packages, where highly flexible interconnects are printed directly on flexible/ bio-compatible substrates (Figure 2A). We are also developing bespoke printed circuit board (PCBs) to be integrated with these packages in order to

35899_WEISS ANNUAL REPORT_0011.indd 21

facilitate wireless communication of the sensor data to smartphones or other handheld devices or secure clinical servers in order to facilitate real time tactile imaging and/or sensor read-out to facilitate better training in obstetrics and also to enable proactive management of clinical birth complications, thereby charting a path for smart and safe births.

06/12/2019 16:53

22

WEISS Annual Report

WEISS REPORT SPOTLIGHT: SPEEDOP R

ui Loureiro and his team work at the interface of surgical and rehabilitation engineering for the optimisation of personalised clinical procedures that bridge the gap between theory/concept and practice for development of new tools and techniques across wide variety of clinical domains. The work centres on pre-operative and post-operative interventions and the development of novel surgical tools and techniques.

35899_WEISS ANNUAL REPORT_0011.indd 22

06/12/2019 16:53

WEISS Annual Report 23

The WEISS Simulation Platform for the dEvElopment of new surgical Devices and Optimisation of Personalised Clinical Procedures (SPEEDOP) currently being developed by Ruiâ&#x20AC;&#x2122;s team is well placed to be clinically relevant and to translate beyond surgical science. The simulator provides accurate feedback on quality of each step performed and facilitate surgical planning and simulation of best- and worst-case scenarios. Our initial work with the concept platform allowed us to teach VR & Haptics to surgeons and presents with an opportunity to see the platform being used in specialised teaching and professional training at the highest level. As we develop the platform further, we roll out new functionality that will be used to teach the next generation of surgeons that see VR simulations combined with data driven intelligence through Artificial Intelligence as part of their pre-operative planning and validation. Aspects of our initial work are being translated already to pre-operative planning in patients with nerve injuries that suffer from neuropathic

35899_WEISS ANNUAL REPORT_0011.indd 23

pain and are at risk of amputation and with patients that have been amputated following cancer treatment. We combine this with 3D printed low-cost novel Bionics limbs developed in our lab to translate the experience from the VR simulator in the treatment of neuropathic pain.

The initial work has led to the delivery of the first VR surgical training course (as part of the UCL MSc Advanced Minimally Invasive Surgery) where we have trained surgeons on how to put together a VR & Haptics simulation from the ground up. From the segmentation of patient specific imaging (e.g. MRI/ CT), 3D model development and optimisation, to uploading to SPEEDOP simulator, assigning material properties, haptic interactions, designing procedural workflows, and implementing metrics to assess user performance. All without one single line of code having to be written by the students! To the best of our knowledge, this has never been done before at this level.

06/12/2019 16:53

24

WEISS Annual Report

WEISS STAFF AND STUDENTS ON THE MOVE In 2019, we welcomed on board...

nn Jazz Dinza, Admin Assistant and PA to Professor Lovat nn Jennifer Child, Senior Trials Coordinator nn Su-Lin Lee, Head of Operations nn Niels van Berkel, Research Fellow nn Keshav Iyengar, Research Assistant nn Sarina Hussain, Quality Manager nn Lukas Lindenroth, Research Assistant nn Catriona Stokes, PhD Student nn Alexander Grimwood, Research Fellow

We also celebrated the promotions of... nn Vanessa Diaz – Professor of Healthcare Engineering nn Dean Barratt – Professor of Medical Image Computing nn Adrien Desjardins – Professor of Biomedical Engineering nn Yipeng Hu – Lecturer in Interventional and Surgical Sciences nn Francisco Vasconcelos Lecturer in Robotics and Computation

nn Hoang Ha Le, Research Fellow

And sent our best wishes for the future to...

nn Ching-Mei Chen, Research Fellow

nn Evangelos Mazomenos

nn Nachappa Uthraraj, Clinical Training Fellow

nn Henry Tregidgo

nn Mo Hussain, Clinical Training Fellow

nn Nikolina Travlou

nn Francois Chadebecq, Research Fellow

nn Maria Robu

nn Joanna Brunker, Lecturer

nn Laura Marmor

nn Rawen Kader, Clinical Training Fellow

nn Sandy Mosse

nn Zac Baum, PhD Student

nn Geoff Jones

35899_WEISS ANNUAL REPORT_0011.indd 24

06/12/2019 16:53

Using the fume cupboards in the laboratories in Charles Bell House

35899_WEISS ANNUAL REPORT_0011.indd 25

06/12/2019 16:53

26

WEISS Annual Report

SOCIAL AT WEISS A

t the very heart of WEISS is our core mission – to bring together engineers and clinicians, so that they can work together and bring about improved outcomes for patients.

The WEISS Social and Events Committee works hard to create opportunities for all different disciplines to come together, talk shop, and have some fun! Whether it be a coffee morning, karaoke night or an impromptu tournament at the ping-pong table, we know that there’s more than one way to foster great collaborations.

The Social Committee is responsible for organising Centre events, from small-scale socials right up to the annual Away-Day and Winter Workshop. We’re very grateful to them for giving up their time – it wouldn’t be WEISS without you!

35899_WEISS ANNUAL REPORT_0011.indd 26

06/12/2019 16:53