Rotational Angiography for 3D Vascular Imaging

In a recent issue of “Circulation: Cardiovascular Interventions”, researchers at the University of Colorado (Aurora) report on the use of rotational angiography to produce three dimensional images of vasculature. When used in interventional cardiology, physicians will be able to visualize clogged arteries, aneurysms or other disease states in order to diagnose them or perform preoperative planning, such as in angioplasty and stenting Importantly, this imaging can be done without the use of systems of the gargantuan scale of MRI, SPECT or similar systems, and would even require less radiation, reducing patient risk.

The achievement is made by conventional angiography, in which contrast dye is injected into the patient’s vessel, but unlike 2D angiography, rotational angiography uses a rapidly rotating detector to capture the x-ray’s “shadows” from all sides. Then software is used to construct the images.

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Technologies at medical technology startups

Medical technology startup companies that we identified during the month of October 2009 are developing the following specific technologies:

  • Diagnostic imaging in urology and oncology.
  • Endoscopic tissue management technology.
  • Esophageal monitoring device to replace peripheral artery catheter.
  • Products for treatment of fecal incontinence and GERD.
  • Surgical instrumentation to reduce trauma of surgery.
  • Suction device for use in sleep breathing disorders.
  • Fully absorbable coronary stent.
  • Drug-eluting balloons.

Source:  Medtech Startups Database

Healthcare and medical technology ups and downs through 2009/2010

Looking at the course of developments — in the healthcare reform "debate" (as it were) and medical technology — it is not a huge leap of judgment to make the following predictions for the ups and downs of healthcare overall and for specific medical technologies.

Predictions for the healthcare market

  1. A healthcare reform package will pass this year, but it will fall short of what anyone wants or fears (the U.S. will not have a government takeover of healthcare nor become a socialist state despite the outrageous hyperbole flying around and the constrained legislation will do little to address the problems in healthcare).
  2. Through 4Q 2009, startup and early stage medtech company failures will begin to abate, while new company formations will ramp up. 
  3. Investment and manufacturing will pick up in healthcare.  Mid-size and larger companies’ hiring will lag the hiring rate (and relative amounts) of startup and early stage hiring.  By year-end 2009, investment will see a BIG uptick at startups, early stage and later medtech companies. 
  4. Regulatory, liability and other adverse scrutiny of medical device, pharma and biotech will reach a fever pitch into late 2009, early 2010.
  5. Despite the investment and hiring constraints at mid-size and larger medtech companies, stock prices will steadily rise through year-end and into 2010.

In terms of specific technology forecasts…

  1. Stem cell therapy developments and advances will begin to appear at a startling rate in late 2009.
  2. The coronary stent market will become increasingly fragmented as new DES products reach the market.
  3. Traditional general surgical technologies (e.g., "open" procedures") will become rare, eclipsed by single port or incisionless laparoscopy and NOTES procedures.  Robotic surgery will continue to draw more headlines than sales.
  4. Obesity devices and drugs will be one of the most active areas of medical technology developments through 2010 and beyond.
  5. Despite the intuitive appeal of diagnostic technologies (especially imaging technologies) for preventive medicine, there will be considerable pressure to restrict their use due to their contribution to healthcare costs.

Sample of one: surgery, electronic patient records, other insights from an ER visit

Insights from a trip to the ER:

  • img_0004For even a minor laceration ("only" four stitches), cyanoacrylate-based surgical glues (e.g., Dermabond) will be ineffective unless the site is entirely free of blood.  While cyanoacrylates have an advantage in adhesive strength, their toxicity for internal applications, plus this need for bloodless field, seriously limits their potential.
  • The involvement of the commonly used blood thinner, Plavix, has a very distinct impact on what would otherwise be minor bleeding.  Minor epistaxis, for example, can require an ER or urgent care visit if the patient is on Plavix.
  • Digital imaging (x-ray) has a very direct, positive impact on patient care.  The ability to obtain a computerized image rapidly that can be readily transmitted from Radiology to the patient record accessible by the ER doc shortens the gap between the x-ray order and the doc’s ability to make a clinical decision based on the results. This improves time and improves the efficiency of the visit as well as the usefulness of the patient record.  Imaging difference in quality compared to film is probably relatively insignificant.
  • Healthcare, despite many advances, remains fairly inefficient, even in the best facilities.  The need for coordination across multiple departments (even between triage and ER units), with patient records, and the lack of point-of-care imaging causes delays in patient care, tying up beds and delaying the clinical decision-making of ER docs.  Electronic patient records that are accessible across different points of care (doc offices, ER, etc) would speed care and reduce complications (e.g., patient record always reflecting the most current presciptions and their dosage).
  • Peer review of new technology is a necessary check and balance against unproven developments, but still delays the adoption of potentially important new options available to the clinician.  Manufacturers have a significant hurdle in penetrating the mainstream, routine use of new technologies, but can minimize this in having a highly focused effort on delivering technology with value that clinicians can readily appreciate for its ability to improve clnical outcome, save time or otherwise improve patient care and the ability with which clinicians can deliver it.
  • Mission Hospital in Mission Viejo, CA, has an excellent level of service

I appreciate any feedback others have on heealthcare experience, especially as it may be driven or influenced by technology.