Fraunhofer-Gesellschaft zur Förderung der angewandten Forschung e.V. of München at MEDICA 2019 in Düsseldorf -- COMPAMED Trade Fair
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Nov 4, 2019

InnoHealth China promotes your ideas

eHealth and Bioeconomy 
 
InnoHealth China is the current campaign led by the Fraunhofer-Gesellschaft and constituent part of the initiative Research in Germany which is initiated and financed by the Federal Ministry of Education and Research (BMBF). The campaign aims to connect the Chinese and the German healthcare research sectors, also involving small and medium-sized enterprises (SME) and start-ups. Applying for the Call for Ideas & Innovation until December 16, 2019, you may get the chance to be part of an international network and to learn about realizing your project.

InnoHealth China's Call for Ideas & Innovation addresses representatives from research organizations and those from SMEs and start-ups who develop application-oriented technologies and/or processes in the fields of eHealth - with the subtopics Artificial Intelligence and Telemedicine - and Bioeconomy - with Bioeconomy, Biotechnology & Drug Discovery, Precision Healthcare and Healthy Food. The campaign intends to initiate and strengthen project development with Chinese research institutions and companies, which ist why the Fraunhofer-Gesellschaft is offering an exclusive delegation trip, the Matchmaking Tour, to China, for the winner of the Call. These winners, a total of 10 German Research-SME-Tandems, will also participate in a workshop for promoting research and find out about possible funding programs. In addition, the German participants may invite their Chinese partners for the German R&D Tour to Germany in order to continue their cooperation dialogues.

InnoHealth China
The campaign InnoHealth China is the first of three within Research in Germany. Two more campaigns - each of them focussing on different topics and regions - will follow until 2023. More about the campaign, the call and the application documents can be found on: www.research-in-germany.org/innohealth/call

Research in Germany
The initiative „Research in Germany" is launched and financed by the Federal Ministry of Education and Research (BMBF) serving to promote Germany's research landscape and its latest research achievements across the world. This central marketing is conducted by the German Academic Exchange Service, the German Research Foundation, the Fraunhofer-Gesellschaft and the International Office of the BMBF.

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Nov 4, 2019

Combatting stress with a headband

New, objective measuring method for occupational health management
Stress at the workplace can produce a wide range of symptoms and has previously only been describable in subjective terms. Headache after a day at the office? Exhausted from all the noise in the shop? Stress as a possible cause is now becoming objectively measurable thanks to Fraunhofer IGD technology.

Back pain and other physical problems as the main cause on doctor’s notes are a thing of the past. “Today, it’s more and more often mental strain caused by stress,” explained Dr. Gerald Bieber from the Fraunhofer Institute for Computer Graphics Research IGD in Rostock. “The results are high blood pressure or heart conditions, but also, most importantly, psychiatric disorders such as depression. Then workers are totally absent for weeks at a time. The impact on businesses is enormous.” The solution: a system for detecting stressors in time and improving working conditions.

Until now, workplaces have been analyzed for mental stress through questionnaires and meetings. “But those are subjective assessments by an individual,” said Dr. Bieber. “We need objective metrics.” This is why Fraunhofer IGD is researching sensors that record the physical signs of stress, including blinking frequency, pulse and breathing rate, oxygen saturation, skin conductance and even brainwaves. The University of Rostock is integrating these sensors into a headband that can be easily worn while working. It also registers ambient parameters, such as noise level and light exposure. Stressors such as noise, drafts or light affect everyone differently. “LED lights are becoming more common and their brightness varies greatly in a very quick rhythm,” explained Dr. Bieber. “We aren’t consciously aware of it, but our brain still registers the stimulus. If you look at this light on a time-loop, you’ll see that its intensity often drops by up to half or it even goes out altogether before going back up. That’s taxing.” Even fluorescent tubes have this effect. To create a way to remedy this situation, Project SEBA was started to create a sensor-based assessment system for mental stress and strain in the workplace. The measuring system should be flexible, wearable without being a nuisance even during physical activity and still provide reliable data. The result is a headband packed with sensors and circuits. It is designed to be worn by workers for about four hours in order to obtain reliable data, with each person’s initial state being recorded as the baseline. The entire process is controlled and visualized by smartphone, through which subjective impressions can also be entered and included in the analysis. “It’s important to our research in order to continue improving the system,” said Dr. Bieber.

The first field tests will begin at the end of this year at a handful of companies experiencing a high level of psychological strain due to a large number of employees being out sick. However, the meter is not intended to go to businesses themselves later on, rather to external occupational health management (OHM) consultants who are currently conducting the conventional workplace analyses. “The data from our measurements naturally will not be disclosed to employers,” ensured Dr. Bieber. “The ambient data will go to consultants so changes can be made at the workplace. And only when the workers give their consent will their personal measurements be included.” As a result of this analysis, certain factors can be modified depending on how a worker responds to the stressors. “It would be simple to replace a light or set up a partition to block out noise in order to relieve the strain on workers.”

The University of Rostock’s Project SEBA is being funded by the Federal Ministry for Economic Affairs and Energy. Fraunhofer IGD’s partners on the project are Hamburg Applications, which is developing the software, Health Care 4.0 from Potsdam, which specializes in data protection and, last but not least, the University of Rostock, which is covering the psychological aspect. Previously, IGD was working mostly with pattern recognition from images. Now, as Dr. Bieber explained, the same math is being applied to recognize patterns from sensor signals.

The headband will be presented at Medica, the world’s largest healthcare trade fair, which is being held in Düsseldorf in November. “There has yet to be any application like this in occupational health management,” said Dr. Bieber. The mobile meter has already drawn the interest of specialists in other fields, such as doctors who want to treat phobias or sleep disorders.Also at Medica, Fraunhofer IGD will present its digital control station for the healthcare sector: Health@Hand is a compact information center for use in hospitals and care facilities. As a visual control station, it clearly displays all health and administrative information to staff by using a virtual representation of the real ward. Health@Hand can interact with all facility information while also meeting every security standard for this sensitive information. It significantly speeds up and facilitates necessary administrative and handover tasks within a ward, and the time saved benefits patients.

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Nov 4, 2019

Preventive health care via app

MEDICA 2019: Prevention through digital helpers from Fraunhofer and partners

Demand for apps for preventive health care is growing all the time. Particularly popular are diagnostic assistants that record physiological and fitness data. However, there are data protection concerns with these tools. Researchers at the Fraunhofer Application Center SYMILA in Hamm have developed two prevention apps that safeguard users’ data protection rights. While teamFIT is aimed at sports trainers who want to monitor the current state of fitness of their teams, BAYathlon is designed to help detect a specific form of cardiac arrythmia at an early stage. From November 18 to 21, the team of researchers will be demonstrating how the apps work at MEDICA 2019 in Düsseldorf (Hall 10, Booth G05).

Atrial fibrillation is one of the most common types of cardiac arrythmia in adults. If the condition remains undetected, it can lead to a stroke. With BAYathlon, a team of researchers at the Fraunhofer Application Center SYMILA in Hamm, a facility operated by the Fraunhofer Institute for Applied Information Technology FIT in Sankt Augustin, has developed a diagnosis app that enables atrial fibrillation to be detected on time. The project is being sponsored by industrial partner Bayer AG, which was closely involved in the research work. Bayer is also conducting a study in tandem with the project.

The app, which runs on all devices from Android 4.4 onward and on iOS as of Version 9.3, will be used in conjunction with a chest strap or a heart rate monitor on the wrist – usually when doing sport or exercise, such as jogging or cycling. A heart rate measurement device is built into the strap or monitor and transmits the measurement data to the user’s smartphone via Bluetooth. BAYathlon then evaluates the live heart rate data shown on the display. “A characteristic indicator of atrial fibrillation is that the heartbeat interval exhibits strong fluctuations within a few seconds. If a certain fluctuation threshold value is exceeded, the integrated algorithm recognizes it. If there is anything conspicuous, an acoustic warning signal sounds,” explains Michael Fuchs, scientist at the Application Center SYMILA. A message appears on the display telling the wearer of the device to take a break. In addition, the measurement results are graphically documented, so that doctors can initiate therapies if required.

The app has already been tested with the help of test data records and achieved a success rate of 95 percent.

Another advantage is that the data is saved in the app and processed there; there is no need for an Internet connection. Because data is not sent to the server, the user’s dataprotection rights are safeguarded. A further USP is that BAYathlon can be used in conjunction with all measurement devices that support open source.

An app that minimizes the risk of injury
With teamFIT, which is based on the teliFIT platform, trainers receive a tool for objectively evaluating the current state of fitness of the athletes under their care. The goal of the prevention app is to detect early signs of a looming injury that could put a player out of action for a lengthy period of time. In such cases, the trainer can reduce the athlete’s training workload, for instance, so as to ease the strain on the affected area. In professional sport, finding the perfect balance between all-out intensity and periods of rest is critically important. The app helps trainers to achieve this. teliFIT is already being used by the second-division German handball team ASV Hamm-Westfalen e.V., but the license is available to all sports clubs. It supports both iOS and Android devices.

Players use the app several times a day, before and after every training session, when they answer certain questions and provide information about things such as their general state of health, their sleep pattern and their training. The trainer receives the evaluated data for all players for every day in a clear overview. Parameters such as wellness score, chronic strain, acute strain, EWMA (exponentially weighted moving averages), freshness index, ACWR (acute chronic workload ratio), monotony index, and stress, help the trainer to estimate the athletes’ fitness condition. “The app anonymizes each player’s answers so that they cannot be identified by their teammates. For their part, trainers are saved the tedium of laborious questioning and the filling out of Excel lists,” says Prof. Harald Mathis, scientist at Fraunhofer FIT and director of the Application Center SYMILA.

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Nov 4, 2019

Improved biopsies with MRI-compatible ultrasound system

MEDICA 2019: Minimally invasive diagnostics with multimodal imaging

Biopsies are standard procedures in interventional radiology, not least for patients with a suspected tumor. In this instance, magnetic resonance imaging (MRI) is increasingly the method of choice for guiding minimally invasive tissue sampling. Yet this involves having to undergo repeated MRI scans, which patients find uncomfortable. In an ongoing R&D project, Fraunhofer researchers have now developed a system that allows acquisition of ultrasound images simultaneously to an MRI scan. These multimodal data are then combined and permanently mapped onto one another, meaning that the high-contrast MRI images can still be utilized, in combination with the live ultrasound images, once the patient is no longer inside the MRI scanner. In other words, only one MRI scan is required at the beginning of the biopsy procedure. Afterwards, the biopsy can be safely performed under the guidance of a combination of real-time ultrasound images improved with MRI contrast. The MRI-compatible ultrasound system will be on display at the MEDICA trade fair in Düsseldorf from November 18 to 21, 2019 (Hall 10, Booth G05).

When doctors discover a tissue abnormality, the next step is generally a biopsy in order to determine whether the suspected tumor is malignant or benign. As a rule, this involves a series of MRI scans, whereby the patient is repeatedly placed, in a supine position, within the confined tunnel of an MRI scanner. All in all, it is a time-consuming procedure.

“At present, the patient is given an initial MRI scan and then removed from the scanner,” explains Dr. Marc Fournelle, scientist at the Fraunhofer Institute for Biomedical Engineering IBMT. “On the basis of this scan, the doctor now plans the needle path during the biopsy. The needle is then inserted a little way into the patient’s body, and a second scan is taken in order to monitor the position of the needle. The doctor successively advances the needle into the patient’s body, pausing after each step in order to conduct another MRI scan so as to check the position of the needle.”

In a project designed to shorten the time required for this procedure, scientists from Fraunhofer IBMT have now teamed up with fellow scientists from the Fraunhofer Institute for Digital Medicine MEVIS and from Saarland University Medical Center. KoMBUS aims to combine the virtues of MRI and ultrasound in an MRI-compatible ultrasound system. The idea behind KoMBUS is to reduce the process to one MRI scan, with all the planning for the needle path and the actual tissue biopsy being performed under ultrasound guidance. This improved procedure not only brings about an increase in patient comfort; it also allows saving expensive MR-scanner time and thereby reduces the costs of diagnosis. The project, which will run until the end of the year, has been funded by the German Federal Ministry of Education and Research (BMBF) to the tune of 1.4 million euros.

Live ultrasound images show patient’s exact breathing phase
The MRI-compatible ultrasound system produces ultrasound images in parallel to the MRI scan and maps one onto the other. In effect, this provides the physician with an MR image of the patient’s current breathing phase, despite the fact that the patient is no longer in the MRI scanner. This combination of high-contrast MRI images and live ultrasound images enables to plan the needle path without the need for repeated MRI scans. “Each time the patient breathes in or out, the positions of the internal organs shift,” Fournelle explains. “The physician must therefore plan and perform the biopsy in one and the same breathing phase. Otherwise, the organs will have moved as a result of the change in lung volume and there is a risk that the needle will be off target and fail to hit the suspect tissue.”

This new system from the Fraunhofer team simultaneously produces both ultrasound and MRI images over several breathing cycles while the patient is in the MRI scanner. An MRI scan is conducted for each breathing phase, with the result that low-contrast lesions are also visible when scanning with ultrasound by showing the corresponding MR image. Once the patient has been removed from the MRI scanner, the system employs special algorithms to identify the current breathing phase on the basis of the live ultrasound images and then searches through the recorded MRI datasets for the scan that corresponds to that precise breathing phase. For less-experienced physicians, this new system provides valuable assistance. Another advantage is that it reduces demand for MRI time, which is expensive and often oversubscribed. This new MRI-compatible ultrasound system marks a key step in the development of alternative MRI-guided biopsy methods, in that it reduces demand for MRI time without impairing the quality of care.

The system comprises an MRI-compatible monitor, two ultrasound transducers and MR-compatible multichannel ultrasound electronics. One of these ultrasound probes is for tracking patient motion. It is fastened to the patient’s body and generates live images of the movement of the inner organs. The second (handheld) probe can be used for real-time monitoring of the needle position following the MRI scan. Also included in the system is software used to plan the needle path, which was developed at Fraunhofer MEVIS in Bremen. This tells the user when the patient is in the ideal breathing phase and displays the MR scan corresponding to the actual phase. In addition, the software also proposes an optimal needle path, including the needle target and angle of approach.

Tests on a phantom model have demonstrated the proper functioning of the hardware-software combination. Proposals for clinical studies have now been submitted, and these are expected to get under way over the next few months at Saarland University Medical Center. In addition, the research team will be presenting an initial demonstration model of this system at the joint Fraunhofer booth (Hall 10, Booth G05) at the MEDICA trade fair in Düsseldorf from November 18 to 21, 2019.

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Nov 4, 2019

Neural networks enable autonomous navigation of catheters

MEDICA 2019: AI support for endovascular stroke therapy

When a patient has a stroke, every minute counts. Here, prompt action can prevent serious brain damage. If a clot is blocking a large blood vessel in the brain, surgeons can remove this occlusion by means of a catheter inserted in the patient’s groin. However, this is a complicated procedure, requiring a lot of experience, and only a few specialists are capable of carrying it out. In new work, Fraunhofer researchers have been investigating whether artificial intelligence might be used to steer a catheter automatically and reliably to a blocked blood vessel. Initial tests with a simulation model and in the laboratory have been highly promising. The research team will be demonstrating this new technique on a blood vessel phantom at the MEDICA 2019 trade fair in Düsseldorf from November 18 to 21 (Hall 10, Booth G05).

In Germany, around 270,000 people suffer from a stroke each year. This sudden disruption to the supply of blood in the brain requires prompt medical attention. If not treated in time, a significant number of brain cells can die, leaving the patient with lasting damage such as paralysis or a speech impediment. In the worst case, it can prove fatal. Increasingly, the therapy of choice is a so-called thrombectomy. Here, a thin catheter is inserted into an artery, via the groin, and advanced to the aorta, from where it is threaded all the way up to the blocked blood vessel in the brain. Once the blocked vessel has been reached, a special instrument known as a stent retriever is opened to reveal a tiny, basket-like mesh that becomes firmly entangled with the blood clot. The catheter is then withdrawn, along with the clot. This procedure takes anything from 45 minutes to three and a half hours, depending on the skill of the operator. The ability to conduct a thrombectomy requires long training and plenty of practice. Depending on the specific case, anything between ten minutes and one and a half hours are required to navigate the catheter to the blood clot. Researchers from the Mannheim-based Project Group for Automation in Medicine and Biotechnology PAMB – which is affiliated to the Fraunhofer Institute for Manufacturing Engineering and Automation IPA – have been taking a closer look at this problem. Their idea is to use a robotic system – in the form of a computer-controlled catheter – to establish a faster and more reliable alternative to this painstaking procedure. In a new departure, they have harnessed the power of artificial intelligence to guide the catheter autonomously to the site of interest. “The surgical intervention itself, in which the blood clot is removed by means of the stent retriever, is still carried out by a physician. But the actual journey to the blocked blood vessel, where various anatomical difficulties have to be negotiated, is undertaken solely by an autonomously controlled catheter,” explains Johannes Horsch, one of the project group’s engineering scientists. “This procedure can be used not only for removing blood clots but also in other types of endovascular surgery, such as treatment for cardiac infarction or liver tumors.”

Autonomous navigation based on deep reinforcement learning
The species of artificial intelligence that enables the catheter to navigate autonomously is known as deep reinforcement learning (DRL). This is one of the methods used to train neural networks, and it closely resembles the way in which people learn. The specific characteristic of DRL is that the data used to train the neural network are automatically generated by an algorithm in the course of repeated practice on a computer simulation model – in this instance, a virtual reconstruction of the vascular tree and a catheter, with which the algorithm interacts. In addition, the researchers have developed a second algorithm to evaluate whether the action taken is right or wrong. If, for example, the guidewire is correctly turned to the right and inserted into the correct blood vessel at the next junction, the first algorithm is awarded one or more plus points, e.g., +1. If, however, the algorithm makes an incorrect decision, a minus point is awarded. This feedback enables the algorithm to learn autonomously, so that the neural network continuously adapts and improves. “Using the model, we can simulate all the possible movements of the catheter and train the neural network to a certain level,” Horsch says. “So far, we’ve had a 95 percent success rate with the simulation model – i.e., in a simplified scenario, the catheter was autonomously navigated to the blocked blood vessel without problem. Our aim is to nudge that up to 99 percent by the start of MEDICA.”

For autonomous navigation to function in an actual surgical intervention, the position of the catheter must be tracked in real time. This is where another project partner, the Fraunhofer Institute for Digital Medicine MEVIS, enters the picture. Researchers there are developing an intelligent catheter, which is tracked in the vascular system via fiber-optic sensors and without any imaging. In addition, they are using fluoroscopic images to train a neural network to withdraw the catheter through the vascular system. The next step will be to take these results, generated with a simulation model, and transfer them to a phantom – i.e., a model, made of plastic, of the entire blood vessel tree from the groin to the brain.

Packed with the practical knowledge of many experienced surgeons
A lot of experience from practicing physicians has flowed into building an algorithm that will navigate the catheter swiftly and reliably through the vascular system. A key benefit of this new technology is that it will narrow the huge variation in the time taken for such a procedure – a variation that is the result of differences in patient anatomy. Equally important, it will enable smaller clinics, without trained specialists in this field, to offer endovascular stroke therapy. At present, only specialized stroke units have the relevant equipment and medical expertise to carry out such treatment.

Catheter threaded over and along the guidewire
For the moment, the researchers are using a guidewire in the simulation tests. The next step will be to try navigating a catheter which is threaded over and along the guidewire like a sheath. “In current practice, the catheter follows the guidewire. Once the guidewire has reached the right blood vessel, the catheter is pushed into place,” Horsch explains. The team is hoping to develop the use of two or three increasingly fine catheters, one inserted inside the other, so that the smallest will fit inside the minuscule blood vessels in the brain, which are much narrower than the blood vessels in the groin region.

The project is scheduled to run until September 2020. By then, the researchers will have completed preclinical testing on the silicon phantom of the blood vessel tree and perfected the algorithm used to navigate the catheter. Follow-up projects will then focus on optimizing the procedure, in particular with regard to its safety and reliability. After that, a further four to five years have been set aside for clinical studies to demonstrate its safety and efficacy. “It will no doubt take another ten to 15 years before the system can be commercialized for use in hospitals,” Horsch says. “Before then, a lot of research work and clinical studies will be required. And, in addition to all that, lawmakers will have to issue regulatory approval for the use of neural networks in a medical context.” Horsch and his colleagues will be demonstrating the latest results of their research at the MEDICA trade fair in Düsseldorf from November 18 to 21, 2019 (Hall 10, Booth G05).

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Nov 4, 2019

A gentler technique for artificial respiration

Fraunhofer tech at MEDICA 2019: Intensive care for premature infants

In intensive care wards, artificial respiration is often used as a last resort to save a patient’s life. Unfortunately, however, it brings with it the risk of acute or chronic lung damage, particularly if the ventilator is working against the patient’s respiratory impulse. Therefore, researchers from the Fraunhofer Project Group for Automation in Medicine and Biotechnology in Mannheim are working on an innovative new sensor aiming to provide a gentler way to administer artificial respiration, especially for children and newborn infants. A prototype of the sensor system will be on display at the MEDICA trade fair in Düsseldorf from November 18 to 21, 2019 (Hall 10, Booth G05).

Premature infants often require intensive care such as artificial respiration due to their underdeveloped lungs. This leads to multiple potential complications including volutrauma, which is inflicted by the ventilator pumping too much air into the tiny lung. Moreover, it can also lead to barotrauma, when the ventilator applies air at too high a pressure, especially during the infant's exhalation. To avoid these sorts of complications, doctors exercise particular caution when dealing with such tiny, fragile patients. For instance, the tube is not sealed airtight within the trachea as would be the case for adults. This allows some of the air to escape, thus reducing the risk of trauma. However, it also prevents doctors from providing their young patients with optimal respiration.

To solve this problem, Jan Ringkamp and Jens Langejürgen of the Fraunhofer Institute for Manufacturing Engineering and Automation’s Project Group for Automation in Medicine and Biotechnology PAMB are working on a gentler approach called Thorax Monitoring. “Essentially, it’s a small measuring device that detects whether a patient undergoing artificial respiration wants to breathe in or out,” Ringkamp explains. “This would allow ventilators to continually adapt themselves to the patient’s breathing pattern. Zero volu- or barotrauma with optimal respiration – THAT’S the goal,” Langejürgen says.

Thorax Monitoring system detects patient’s breathing pattern
The Thorax Monitoring system uses two antennae attached to or next to the patient’s chest with one antenna transmitting an electromagnetic wave and the other receiving it. The principle is that muscle, fat and tissue all have different electrical properties from air in the lungs. Despite sounding rather complex, the general idea is quite simple: When a patient inhales, the lungs expand as they are filling with air. The electromagnetic wave travels faster through air than tissue. When the patient exhales, it is the opposite way round: The lungs contract, the electromagnetic wave must travel through more tissue, and thus its progress is slowed.

In other words, there is a measurable difference between inhaling and exhaling that can be picked up by the Thorax Monitoring system. It works for premature infants and any other patients incapable of breathing on their own but whose bodies are still making the attempt. “Even if the expansion or contraction of the lung is extremely minimal, it still has a measurable effect on the signal. Lab testing has shown that we can detect changes well under one millilitre,” Ringkamp says. “The Thorax Monitoring system tracks the patient’s attempted breathing pattern and can direct the ventilator to provide support accordingly. One advantage of our approach is that we don’t have to attach sensors to the patient to do it – which is especially important given premature infants’ highly sensitive skin,” Langejürgen says.

The scientists have already built and tested an early prototype. In November, they will be showcasing it to a specialist audience at the MEDICA trade fair (Hall 10, Booth G05). The stand will feature a small doll hooked up to a ventilation bag, with visitors being able to administer ventilation themselves. The doll’s body is filled with water with an artificial lung to displace the water and two antennae attached to its chest. A screen will show the Thorax Monitoring system tracking and processing the signal.

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