Digital twins, how medicine is changing

Digital twins, how medicine is changing

Digital twins

Put your head and gaze into a heart before operating on it. Obtain a three-dimensional model of an aneurysm to understand how to intervene. Experience what happens during radiotherapy in an immersive way to be less anxious when you really lie down on the couch. Carry out much of the process of conceiving, developing and testing a new device using simulation models, patient avatars, big data and artificial intelligence. It's not science fiction, of course, but they are just some of the applications that are already possible today (some actually operational, others at demo level) thanks to the digital twin paradigm applied to the health sector.

With a dutiful premise : today with digital twin (or virtual, if you prefer) in the digital health field we mean applications that are also very different from each other, ranging from those that require you to wear a helmet and physically move in space up to others that are used directly through a screen or a graphical interface, and in which the technological core is represented by the output of simulations and data processing, even without the need for a three-dimensional model or other particular special effects. But let's go in order.

Inside the laboratory

For we recently entered the 3DExperience Lab of the Dassault Systèmes headquarters, in Velizy Villacoublay in Paris, to get some news about 3D software solutions who are entering - or will soon - enter the healthcare world. And if in itself the idea of ​​creating digital models of an object to study its characteristics certainly does not sound like a novelty, much more recent are the applications to the soft tissues of the body in terms of personalized medicine and also to the prototyping and experimentation of new digital health devices. “We call ourselves The 3D Experience Company and have been doing what is now called a digital twin for over forty years, starting with the first aircraft wing mock-ups in 1989,” said life sciences & healthcare industry vice president Claire Biot.

“But the entry of this approach into the life sciences sector (which for Dassault also passed through the acquisition of Medidata in 2019, ed) poses new challenges to make treatments and devices ever more performing, accessible, economically sustainable and above all useful for health professionals and patients”, he adds. And how do you imagine research and development in the healthcare sector twenty years from now? “If today 95% of crash tests in the vehicle sector are carried out virtually, we imagine that clinical trials will gradually become the same, with digital twins carrying out the vast majority of tests and trials, all in silicon” , he replies.

Mind and heart as a digital twin

If we create realistic simulations of human organs, can we really achieve a significant improvement in medical care? This is the question, probably rhetorical, that many of the companies that have been working for years on the creation of digital twins of specific human organs and physiological functions are asking themselves. And it is also the bet on which Dassault Systèmes has decided to bet through two projects called living heart and living brain , Living Heart and Living Brain , now in an advanced stage and which have followed a development process of more than ten years.

The former aims not only to support the development of safe and effective cardiovascular products and treatments, but also to provide personalized interventional assistance based on the characteristics of the individual patient. If heart disease still represents the leading cause of death in the world today, the most recent frontier of innovation is represented today by the introduction of virtual patients, i.e. avatars made up of a set of data and absolutely realistic clinical parameters, generated starting from real patients but not corresponding to a specific real person.

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Living Brain , on the other hand, is a digital twin project that looks at a specific application, namely the improvement of surgical performance and outcomes for people with epilepsy who are undergoing surgery. If more than two thirds of people suffering from epilepsy can be successfully treated through a pharmacological approach, in the other cases an alternative option is represented by a surgical operation. Here a line of development opens up which has led to the world of health even companies that traditionally dealt with something else: to date there is no reliable predictive system to establish the probability of success of neurosurgical intervention, leaving many patients in a condition of uncertainty about what to do. And it is therefore through simulation systems that can be customized on the characteristics of the single person that work is being done to obtain a satisfactory predictive power, for the benefit of neurosurgeons but above all of the patients directly involved.

Training for radiotherapy

One of the most curious applications of applying the twin paradigm to virtual reality is the faithful reproduction of a radiotherapy room in every detail. We tried it: from a physical point of view what happens is that you are lying down on a couch (actually a normal sofa) wearing a VR helmet, but for those who are living the experience firsthand it is certainly a particular feeling. Lights, sounds, times and processes are exactly those experienced during a radiotherapy session, with the possibility of simulating the action of the beam on different parts of the body. And what is it for? In fact, to make cancer patients become familiar with what they will then actually have to experience, in order to alleviate anxieties, various worries and possibly prevent strange behaviors or errors at the first session.

Called Vorthex, the reality project virtual is based on the idea that a patient who knows his treatment has a better chance of overcoming the disease, and that becoming familiar with the place and the tools of the treatment improves the state of comfort, increases understanding and reduces apprehension. "The point is not to relax in itself as if it were a vacation - the developers explained - but to relax in the face of a specific stimulus such as that of an operating room, so as to be ready in the real case". Calculating that around 18 million cases of cancer are diagnosed worldwide every year and that 60% of these can benefit from radiotherapy treatment, it goes without saying that being able to prepare patients (psychologically and not only) in advance represents an advantage not only in terms of tranquility but also of efficiency .

“At the moment we are working to establish whether anxiety from cancer treatment is actually reduced - and by how much - thanks to immersive virtual reality, and if all this translates into not only in a reduction of treatment times but also in a better clinical outcome ”, they added. Among the most interesting perspectives there is also the attempt to reduce the need for anesthetics thanks to digital twins: “Digital can offer an effect of estrangement such as to reduce the need for drugs, determining in the patient a detachment from reality strong enough to be effective. This is because immersivity goes far beyond the cortex and reaches the instinctive part of the mind, not just the one typically activated by videogames”.

Three-dimensional innovation

The complex of buildings that form the headquarters of Dassault Systèmes, on the edge of the Meudon forest southwest of central Paris, is also an experimentation hub, incubation and open innovation, based moreover on an unusual model of support in the development of projects, which envisages a path of at least 5 years before moving from the idea to the launch of a product. A choice which, as the director of the 3DExperience Lab Frederic Vacher explained to, is dictated both by the particular field of application of the innovations being worked on - the life sciences - and by the desire to take care of the development of solutions to the minimum details, without pressing excessively on the accelerator.

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There are more than 50 projects currently in the implementation phase, all collected and told in one site. To name a few, ranging from the most high-tech to decidedly low-tech, there is a toy ball designed to empathize with autistic children, an augmented reality virtual reproduction of an experimental solar-powered aircraft, a biomimetic system for replacing cornea , a system for reproducing and printing in 3D the aneurysms of individual patients to prepare doctors before surgical intervention and an innovative system for the creation of customized prostheses.

More closely linked to the paradigm of the digital model are instead air flow simulators (which have had a boom with the Covid-19 pandemic) which can model not only generic environments but also specific rooms and buildings, including motor vehicles, more or less crowded canteens, theaters complete with a deployed orchestra , schools and so on. Without forgetting the Iaso project, a demonstration prototype of a device for the diagnosis and treatment of diabetes whose development is taking place exclusively in a digital environment, with the aim of showing what are the efficiency potentials that the digital twin can also bring to medical devices sector .

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