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Outside looking in

By Omar Ford

Staff Writer

Novarad Corp. is bringing the world of augmented reality (AR) into the operating room. Instead of looking at Pokemon, aliens or exotic locations – common staples of some augmented reality platforms – Salt Lake City-based Novarad is providing a personal look inside patients' bodies from the outside.

The company reported using its Opensight software in conjunction with Redmond, Wash.-based Microsoft Corp.'s Hololens technology in an automated percutaneous lumbar discectomy (APLD) procedure for disk herniation.

The two technologies are used to render patient studies into 3-D and present them in an interactive manner accurately overlaid directly onto the patient's body.

Neuroradiologist Wendell Gibby, who founded privately held Novarad in 1990, said he never imagined imaging technology getting this precise. During an interview with BioWorld MedTech, Gibby, who performed the APLD procedure, was almost at loss for words when describing the technology.

"I could never have imagined this in my wildest dreams," said Gibby, who also serves as CEO of Novarad. "You can walk up to a patient and see the outside of them, but at the same time, with augmented reality, you can see the position of internal things [in the body]."

In the APLD procedure, an image of the patient's spine was taken with computed tomography (CT), then loaded onto the Opensight software. From there the image was transferred through the cloud to the Hololens, which was worn by Gibby. That image was then projected onto the patient's body while Gibby did the procedure.

The company said the image is a life-size rendering with exact alignment and orientation, which is valuable for medical education, research and, of course, surgery.

Gibby said that the company has had some papers published at the American Society of Neuroradiology about the pairing of Opensight and the Hololens, but it's the first time the technologies have been used on a patient.

Reality check

Gibby said when he started practicing medicine, surgeons still used pneumoencephalography, during which most of the cerebrospinal fluid was drained from around the brain by means of a lumbar puncture and replaced with air, oxygen or helium to allow the structure of the brain to show up more clearly on an X-ray image.

"The procedure was very crude," he said. "These patients would have enormous headaches [afterwards]."

He noted that imaging methods have come a long way. Opensight along with Hololens is a continuation of that journey.

Hololens is made up of specialized components that together enable holographic computing. The optical system fits on the user like a visor over the eyes and works in lock-step with advanced sensors.

Gibby said there were numerous applications for this imaging platform in surgeries.

"You can do all kinds of things that could change the surgical spectrum," such as kidney biopsies and appendectomies, he said.

However there were some challenges in using the technology.

Gibby said there were some lighting issues in seeing the images. He said that the hardware needs stronger processing power so the experience can become smoother in the future.

"But it will come," he said.

Novarad executives said they were not aware of any other company that had developed imaging technology to tackle surgical procedures like this.

Novarad said initially this technology could be used for training, but more than likely physicians would see this as transformative and flock to the technology for actual procedures.

Gibby said the company will eventually try to gain FDA approval, but that's a bit down the road.

However, the 27-year-old company has products on the market. In November 2016, Novarad received FDA 510(K) clearance for its Mobilerad native Ipad application to display data on a third-party mobile device for diagnostic use.

Back to reality

AR is quickly taking root into the health care space, offering enhanced imaging and easier surgical procedures. During last year's Cleveland Clinic Medical Innovation summit, AR for surgery made the top 10 list for medical innovations. (See Bioworld MedTech, Oct. 27, 2016.)

This innovation, which emerged from the same technology that fueled the gaming industry, offers surgeons – especially those conducting neurosurgery and retinal microsurgery – the opportunity to better identify tissue structures, said Rishi Singh, of the Clinic's Cole Eye Institute, who noted that his experience with the technique "felt ergonomically better."

AR began getting traction in health care back in 2013, when Mountain View, Calif-based Google, now known as Alphabet Inc., launched its smart glass wear technology. While the device, dubbed Google Glass, was a big hit in the industrial market, it failed to catch on with consumers.

Near the end of 2014, some companies had stopped work on projects associated with the device, mostly because of the lack of customers or limitations of the device (See BioWorld MedTech, Dec. 14, 2014.)

But the innovations in the augmented reality continue.

Last year, HP Inc. in partnership with Mountain View, Calif.-based startup Echopixel Inc., began offering interactive 3-D medical imaging on its virtual reality displays. (See BioWorld MedTech, July 25, 2016.) Using Echopixel's FDA-cleared True 3-D system, clinicians can manipulate and interact with virtual hologram-like images in an open 3-D space, according to the company.

The images are created by software that uses data acquired from traditional CT and MRI scans. The images can be used for enhanced diagnostic applications as well as surgical planning in clinical, educational and research settings.

And earlier this year, engineers and doctors from the University of Maryland designed an augmented reality tool that could project images or vital information right where a doctor needs it to make surgery safer.

Published  July 14, 2017

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