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13 February, 2018 - 15:25 By Kate Sweeney

Cydar’s future looks rosy

Cydar Ltd co-founder Tom Carrell began his vascular surgery career in the 1990’s – ideally timed to experience first-hand the revolution in the early 2000’s when keyhole surgery began to drive better patient outcomes.

However, the new minimally invasive ‘endovascular’ technique meant that surgeons became dependent on video X-ray guidance that produces monochrome 2D images instead of the familiar view of the exact anatomy seen through the surgeon’s own eyes when opening a patient’s chest.

This loss of perception of soft tissue and 3D anatomy meant that poor visualisation rapidly became the major challenge in these surgical operations.

To solve this problem, Carrell teamed up with Graeme Penney, a senior lecturer in imaging sciences at King’s College London to work on ways to improve the images by fusing existing CT images, rich in soft tissue and 3D information, with the live X-ray guidance.

“In 2011, we made a breakthrough,” says Penney. “By combining our novel computer vision algorithms with the computing power then becoming available through the cloud, we realised we could create an automated system that would work with any hardware already in the operating theatre.”

Penney’s unrivalled expertise in 2D-3D image registration enabled the pioneering creation of an image fusion system with hands-free operation. 

Central to this, the computer vision recognises the patient’s individual anatomical features in real-time, searching over tens of billions of potential positions to achieve the accuracy and robustness necessary for full automation.

It is a vast improvement on the early days where it would take pressing a button and waiting for minutes for an updated image. 
The company name is an acronym of the surgeon’s plea in the operating room when the first prototype was in use: “Can you do another registration?” 

Cydar’s cloud computer vision and machine learning (‘artificial intelligence’) software is compatible with all x-ray systems and, because it requires no new hardware, it is easily implemented into operating rooms.

The core technology developed for endovascular surgery is applicable to other clinical specialties that routinely use X-ray guidance such as interventional oncology, cardiology and orthopaedics.

Cydar’s pioneering product, Cydar EV, has CE mark and FDA clearance and is already having clinical impact. Clinical studies of Cydar EV have now measured the benefits of being able to see more clearly: shorter operating times, less radiation exposure to patients and staff, and a reduction in complications. The product has received glowing reviews from surgeons. 

Cynthia K. Shortell of Duke University Medical Center in the US said: “It has been an instant, blockbuster hit with everyone involved in these procedures. Every operating room participant has a story about the way Cydar technology benefits our team-shorter procedures, lower radiation, less contrast agent, and much greater accuracy.”

Dr Peter Goverde, ZNA Stuivenberg Hospital, Belgium said: “This will expand extensively the possibilities of our mobile C-arms and reduce contrast and radiation exposure!”

The Cydar team believe there is much more to come from its with cloud image processing and artificial intelligence approach. 

The company acquires large volumes of imaging data, providing a rich resource for developing new features and products as well as potentially valuable insights into the delivery of healthcare. 

In 2014, Cydar moved to Barrington, a small village outside Cambridge to benefit from the local talent in computer vision, software engineering and deep learning as well as the innovation culture around the university.

“We are truly an AI company at an exciting time to be working in AI in medicine,” says Carrell. “There are many new companies looking at AI with diagnostic imaging, but we are already using AI with interventional imaging to help physicians save lives.

“Using the cloud enables operating rooms to have access to the latest digital technology and insights without the need to constantly upgrade the imaging hardware at vast expense.”


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