Surgery and Imaging

Technology advances in optics, mechatronics, computer systems and automation driven by growth in non-medical sectors provide the foundation for innovative surgical devices.

However, as the growing cost of healthcare constrains hospitals budgets, new clinical systems must also address stringent cost-effectiveness criteria by: improving surgical outcome and patient safety; streamlining workflows to optimise procedure duration and turnover; minimising downtime and postoperative recovery and decreasing the need for staff.

For instance, the CMOS camera technology made affordable by the mobile phone industry has propelled the development of novel endoscopes which are smaller, cheaper, flexible and ultimately disposable. Further cost and size reduction will allow direct visualisation to extend to a variety of other clinical procedures.

Similarly, advances in digital image processing and consumer display electronics have lowered the bar to 3D HD imaging. This applies not just for real-time intra-operative visualisation but also for fusion of pre-operative imaging and intra-operative information, going beyond simple visualisation to include electrical, optical and magnetic sensing, allowing real-time enhanced surgical guidance.

The combination of available visualisation and sensing technologies with fast control systems and accurate micro-mechanisms also fuels the growth of robotic-assisted surgery. While a few of these systems are currently available or in pre-commercial stages, the next generation of products will compete on enhanced capabilities and value-effectiveness.

A critical part of diagnosing injuries and illnesses is the ability to see within the body. Pioneered by Roentgen’s work with X-rays, medical imaging encompasses a wide range of techniques to achieve this. Today, X-rays have advanced to allow both tracking of movement through fluoroscopy and the reconstruction of 3D volumes through computed tomography.

While imaging based on X-rays provides a powerful tool, there are reasonable concerns over the safety for both patients and clinicians exposed to ionising radiation and this has led to a push for lowering radiation dose. Advanced CT scanners now dynamically minimise the exposure required for a given image quality, and clinicians are increasingly looking to use alternatives to fluoroscopy, such as real-time MRI and ultrasound.

While these techniques use different technical means of creating the images, the factors driving their development are common: a desire to provide diagnostic power safely to as wide a patient population as possible. The push for improved diagnostic power has led to the development of new contrast mechanisms, such as ultrasound shearwave elastography, photoacoustics, and the use of hyperpolarised contrast agents in MRI.

The drive for imaging to reach new patients is evident in low-cost devices for emerging markets, such as hand-held ultrasound systems that work with a user’s mobile phone and ultra- low-field MRI scanners. Compact versions of CT and ultrasound systems are being developed for emergency medicine uses, together with telemedicine and machine learning capabilities to allow paramedics to perform rapid on-site diagnosis.