There’s no argument the images you read from all modalities produce clear pictures that allow for accurate diagnoses. But some in the industry feel there is still room for improvement, including making some scanners wireless or colorizing images. Near Infrared Imaging, LLC, believes it can make these advancements a reality with optical ultrasound tomography — a technology designed to create full-color images without touching the body.
Diagnostic Imaging spoke with Michael Feeney, Near Infrared Imaging, LLC president, about how his claim that optical ultrasound tomography could enhance images at a more affordable price.
What makes optical ultrasound tomography unique? How is it different from photoacoustics, and how does the technology work?
Photoacoustic imaging is the most widely researched technology in the industry this century, and it’s very exciting. But we see one component of it as a flaw, and that is having to have a receiver touch the tissue being imaged. Our approach is unique with one main difference. When ultrasound waves come back and hit the surface of the tissue, rather than having a receiver right there to collect them, our camera detects them and converts them into light. So, if you think about it, photoacoustics is like two cell phones wrapped together with a rubber band. Optical ultrasound tomography is one piece of hardware that sends out light that penetrates tissue and detects what comes back as light and provides crystal clear images.
The color aspect is based on existing technology, so we’re not inventing anything new there. We’re just taking existing technology and making it better. For example, near infrared imaging — the light portion of photoacousitcs — always had the ability to detect bleeding in the body, and it’s always been good at detecting the amount of oxygen in the blood. Our light scheme just does it better.
Take, for instance, brain injuries. If an elderly person who has had multiple falls comes into the hospital, we can give a quality — assign a value or color — to pink, active blood and one to dark, pooled blood so the radiologist will be able to differentiate between the two. Right now, that’s difficult to do, but with our technology, it’s easy. It will be particularly important in cases of child abuse or with soldiers who have received a traumatic brain injury. Medics in the field will be able to determine in real-time which soldiers will just suffer bad headaches and which must go immediately into surgery.
This will also be critically important in breast cancer cases. Cancer tumors have two times the rate of hemoglobin because they attract and change blood vessels in the body. We can put a value on those tumors. Early stage, late stage, crystallized tumors — they might appear as magenta, yellow, pink, or blue.
Another benefit of our technology in breast cancer cases is that you’re imaging the entire breast at once. With photoacoustics, you put the light to the breast, convert it to ultrasound, put gel on the breast, and then obtain images through a receiver. There’s no guarantee that two centimeters over there isn’t a tumor that you’re missing. With us, you emit light, go over the breast, up, down, left, right, whatever — light goes in, and sound waves travel into the tissue deep and wide. So, you’re getting information from all around the breast.
Describe some things this technology allows that are not possible with other technologies.
CT and MRI can do some blood differentiation, but not as well as any photoacoustic technology. We, however, have a better light scheme, and we aren’t constricted to one spot. Let’s say you have a case with a 9-year-old kid who takes a line-drive to the head in Little League. He goes to the emergency room. He’s dazed, his fingers are tingling, and the doctor orders a CT. Obviously, this isn’t a great option due to radiation exposure, but you want to make sure there’s no fatal injury. If he’s still woozy, doctors will likely keep him in the hospital and run follow-up CTs to either identify or ultimately rule out any bleeding. That’s just crazy, given that a new British study reported recently that children who have multiple CTs are three times more likely to develop leukemia or brain tumors.
So, basically, you can’t put a price on our being able to assign a color to active or pooled blood. Radiologists can immediately tell if there is any new, fresh bleeding that can be a danger.
What market need does this technology fulfill?
We have a choice once we get funding to build the prototype. Will we be like Google with our own scanner and try to compete against the GEs and Phillips of the world, or will we be Microsoft and sell our product to other photoacoustic companies?
We will likely do the latter and help photoacoustic companies become more successful. They’re no longer limited to one-spot imaging or to needing a receiver. Competitors could use our technology on breast, brain, liver, and pancreas tissue.
There are other new possibilities with the brain. Right now, photoacoustics is limited to tissue because ultrasound waves can’t go through bone, so receiving images of the brain through the cranium is impossible. Since we can detect the waves as light, the images come back really easily. We will now be able to observe what happens in brain disease and disorders, such as epilepsy or schizophrenia.
Currently, we don’t know what happens when someone has a seizure, is in a coma, or what goes on inside a Parkinson’s brain. We can now monitor brain activity for 24 hours without a skull cap or any wiring. We will also be able to monitor brain activity without radiation during surgery as simply as we monitor blood pressure.
In many ways, you can think of optical ultrasound tomography as being to radiology what the automatic transmission was to the car industry. We’re giving radiologists the opportunity to switch from a manual transmission to an automatic.
Do you have an anticipated market launch date?
We intend to build a family of products. First, we’ll come out with a camera that will fit on robotic arms to be used in the operating room. It will be used to provide images through cartilage or bone. Right now, they use CT for that. We hope to have the first product prototype out there within six months.
Realistically, we could have a few products proven and commercialized, making prototypes with all the appropriate specs, and being shipped within a year after funding. Of the 15 most populous countries in the world, only one requires approval from the Food and Drug Administration (FDA). We can have products selling, shipping, and being used in China, India, and Brazil a year from now.
What is Near Infrared Imaging’s long term goal?
The long-term goal is three-fold. First, we will have a scanner that can be used in hospitals during and after surgery to monitor brain activity. It will be the first scanner than can provide continuous 24/7/365, totally safe bedside-monitoring of the brain. Next, we will make a portable device that can be used to triage patients in the emergency room – which kids will have bad headaches from the bus accident and which need greater attention. The third application will be for use at the scene of an injury. Our plan is to build a hand-held device, around 5 pounds, that can be used to detect bleeding in the brain for accident victims. The images will be transmitted over the cell phone network to a neurosurgeon, so he or she will know exactly what to do when the patient arrives. That’s the full-blown product.
Concern about dropping reimbursement rates, or a lack of reimbursement altogether, exists regarding new technologies. How does Near Infrared Imaging anticipate addressing this question?
Addressing the reimbursement question is on the to-do list. To get a CPT code for what we’re doing could be difficult. I don’t know what we’ll be asked to do for that. It is possible that we might not have to worry because there are general ultrasound codes that we could probably use. But I don’t foresee reimbursement being an issue because we’re going to give health insurance providers a very inexpensive alternative to existing technology that would cost only $49,900. Wouldn’t they much rather reimburse $75 for our imaging of the human breast versus the $125 they currently reimburse for a mammogram? Isn’t it more effective to reimburse a hospital $75 for a brain scan versus $1,000 for an MRI? Near infrared wavelight and ultrasound are FDA-approved and have CPT codes. Now, we just have to combine them.