The MICCAI conference 2009

Earlier this week, IXICO was exhibiting at the MICCAI conference in London. This is an international conference to do with the analysis of medical images – with lots of really mathematical stuff presented by computer scientists and engineers. MICCAI stands for Medical Image Computing and Computer Assisted Interventions, so as well as analysis of images, it also has presentations on robotics. The people presenting at the MICCAI meeting are trying to invent new ways of using images to diagnose disease, plan treatment, monitor treatment progress or even control robotic surgery. If you get your work accepted at MICCAI you are doing very well, as less than 10% of work submitted is accepted for a talk.

MICCAI this year was in London, and two of IXICO’s founders – Dave Hawkes and Daniel Rueckert – were involved in organizing it. One of IXICO’s software developers – Sergiy Milko– was also presenting his work.

The people coming to MICCAI all use medical images in their research, and so all have to deal with the problem of moving around these images, collecting them from scanners, ensuring patient privacy rules are obeyed, and sharing the images with colleagues. All too often, the medical images used in this sort of research are not very well looked after – and get lost or mis-placed. If you don’t know what sort of patient the images are collected from, then they become useless for almost all types of research.

That is one reason we decided that MICCAI would be a good place to show everyone Trial Wire - http://www.mytrialwire.com/ – our free tool to share, de-identify and organize your DICOM medical images, and also show people Trial Tracker – our latest product that provides a web-based image management system for comprehensive management of all imaging data from acquisition to analysis. You can get more information on Trial Tracker here www.ixico.com/newproducts/trialtracker

And I nearly forgot – a real highlight of MICCAI was the conference dinner. It was held in the Science Museum. London’s science museum contains fascinating material, from old steam engines to Apollo lander to CT scanners. On the computing side, it contains really ancient computer gizmos - Baggage’s mechanical computer from 150 years go, or the computer memory developed 50 years ago for the Manchester computer). You couldn’t do much image analysis on those systems: modern scanners can generate 1Gbyte of data per patient!

So it was among all these fascinating exhibits that the MICCAI banquet was held – with stilt walkers, jugglers, and a disco. Quite an event!
To find out more about MICCAI go to http://www.miccai.org/

To go electronic or not to go electronic; that is the question.

With 1.6 billion internet users, even more widespread computer users, and the fact that electronic data capture (EDC) tools have now been available for over two decades, it came to me as a surprise to find out that the majority of clinical trials are still conducted using the primitive method of paper data collection and then computerizing them – a long and drawn-out process that is prone to error.

The sceptic within the industry would point out that EDC, despite being around for two decades, has failed to greatly improve the efficiency and accuracy of clinical data capture. Needless to say, this is due to the continued reliance on paper over complete computerization, caused in part by the misconception that electronic data is difficult to validate. If EDC is to take off, the entire process would need to be streamlined and integrated rather than continue an inherently inefficient element in electronic form.

Luckily for the medical imaging industry, there is no paper-based process to replace. From experience, it is safe to say that the use of radiographic films has significantly reduced over the last 10 years. They are instead being replaced by electronic images in the industry-standard DICOM format. However, one would have thought that with the advent of the internet, these electronic data would be transferred and shared electronically. Fuelled partly by the belief that internet transfer is insecure and in part by the lack of internet connection at some clinical sites, medical images traditionally have been burned onto CDs and then couriered off. This has in turn delayed quality checks and turnaround times for further image analysis.

P&G Pharmaceutical estimated that every extra day a drug remains in clinical studies costs the sponsor at least $600,000 in lost sales. For a blockbuster drug, the daily revenue lost could reach $8 million. It is therefore in the interest of clinical trial sponsors to support better electronic processes at the various phases of clinical development to achieve greater overall efficiency. In relation to medical imaging, a web-based image management system would potentially reduce transfer costs, accelerate turnaround times and provide access to data in real time. The electronic nature of medical images means less work is needed to change sponsor attitudes towards a more web-based process, backed by strong documentation of work being conducted under FDA guidelines.

Drifting in the Cloud

‘Cloud computing’ is a buzzword that caught my attention this week. It seems everything that was once firmly grounded – books, music, high street shops and even medical records – are drifting into the ‘cloud’. In a nutshell, this buzz concept means that users do not need to install or maintain any software themselves – all they’ll need is a computer and browser. They will harness the internet as a vast computing resource and connect to them and use them as needed.

Without realizing it, you may be a cloud user already. Facebook, Twitter, Email, YouTube, iTunes all allow electronic information to be stored and processed on computers in the ‘cloud’ and then delivered to you where and when you need it. In the healthcare industry, the web-based personal health records (PHR) is set to revolutionise communication between patients and physicians as both will be able to pull up medical records from the web.

Will pharma companies that run the clinical trials, which only tentatively shifted from ancient paper records to electronic data capture (EDC) and clinical trial management (CTM), embrace the Cloud? We are not sure.

Pharma giant Ely Lilly and Co uses Amazon’s Elastic Compute Cloud (EC2) for its R&D research. They have been ‘able to launch a 64 bit machine cluster computer working on bioinformatics sequence information, complete the work, and shut it down in 20 minutes’ and it only cost ‘$6.40’ (Dave Powers – Ely Lilly Associate Information consultant).

As pharmas seek to reduce time and cost of drug development, the demand for fully integrated, end-to-end clinical solutions will increase. Clinical cloud computing would not only enable a wide range of clinical applications to be tapped from anywhere but also allow for greater access to real-time information and enhanced collaboration between CROs and sponsors.

In relation to medical imaging, it is regrettable that many clinical sites still rely on CDs or specialised equipment to transfer DICOM images. Trial Wire was launched by IXICO as part of its effort to foster the adoption of a simple, web-based image transfer tool. Evidently, a complete cloud based image management is not available, even though its benefits are clear: reduce operational time, real-time access to trial images anywhere in the world, data sharing, enhanced collaboration, and accelerated error correction.

However, all this may just be wishful thinking. Let’s hope that pharmaceutical companies are prepared to drift into the clouds.