New techniques to offer detailed examinations of the lungs are helping offer more personalised care to patients.
Patients are increasingly seeking individualised treatments for their conditions as the healthcare emphasis moves toward personalised medicine.
But in some areas of pulmonology, with diseases such as asthma and COPD that have many phenotypes, it is difficult to adopt an individualised approach as the gold standard for diagnosis – spirometry – cannot differentiate between pulmonary disease phenotypes.
In addition, routine examination of the lungs generally sees a radiologist examine CT scans with the eye, but that only results in larger abnormalities and abnormal patterns being detected.
Increasingly, clinicians and researchers are looking for new techniques that can deliver the detailed diagnosis and treatments required, and demanded, by patients.
Over the past year, the whole sphere of respiratory conditions and pulmonology has been brought into focus as a result of the ongoing COVID-19 pandemic.
“COVID-19 has made the demand for innovative diagnostic techniques greater than ever. We are having difficulty bringing the pandemic under control, partly because the tools we use to detect and treat the disease are not sufficiently responsive to the situation. Hence there is a substantial need for innovation in the respiratory field,” says Dr Jan De Backer, CEO of Fluidda.
It is very difficult even for a practised eye to see small abnormalities. FRI is a quantitative technique that produces a three-dimensional map of all the clinically-relevant structures in the lungs.
A technique that is offering more detailed assessment of disease is functional respiratory imaging (FRI), which shows small abnormalities and also improves follow-up of diagnostics and treatment selection. It shows the anatomy of the airways and blood vessels in the lungs and the flow of air through them at millimetre-level resolution.
De Backer, who developed FRI in collaboration with his father, Dr Wilfried De Backer, Emeritus Professor of Respiratory Medicine at the University of Antwerp, says: “It is very difficult even for a practised eye to see small abnormalities. FRI is a quantitative technique that produces a three-dimensional map of all the clinically-relevant structures in the lungs.”
FRI utilises computational fluid dynamics (CFD) and came after Wilfried De Backer began to think about an alternative to spirometry, with the computer technology adapted to give an accurate, personal representation of the lungs.
FRI analysis involves two CT scans that are transmitted to Fluidda for analysis via Artificial Intelligence (AI) algorithms.
De Backer explains: “We analyse and model the images using a range of computer methods including computational fluid dynamics, a flow simulation system that has its origins in the aerospace industry. That yields a three-dimensional image of the lungs, showing the flow of air and revealing areas of increased air resistance or places where inhaled particles have been deposited.”
An example of how sensitive the technique is can be highlighted with pulmonary hypertension which can be due to constriction of the smallest blood vessels in the lungs.
“We can see abnormalities even in blood vessels with a diameter of only one millimetre,” says De Backer. “That makes FRI a very patient-friendly option for diagnosing and monitoring pulmonary hypertension, which at present is done using invasive pressure measurement in the pulmonary artery.”
Compared to spirometry, which gives a general idea of lung function, FRI gives a detailed, personalised picture which can form the basis for targeted, individual therapy. It offers the advantage to rapidly review expensive treatments and is also cost effective when compared to cardiac catheterisation to diagnose pulmonary hypertension.
FRI – which has FDA approval as a diagnostic tool for pulmonary disease in American hospitals with European approval expected this year – has a role in pharmaceutical research, providing stable parameters for clinical trials, lends itself to predicting clinical outcomes, such as in COVID-19 patients and for assessing treatment progress.
In conclusion, De Backer notes that the pandemic is showing the world the need for innovations in pulmonary medicine.