Top 10 Medical Innovations for 2009

For the third year in a row, Cleveland Clinic doctors and consultants have picked the medical innovations they think will rise to the top next year.

The Top 10 Medical Innovations for 2009 were announced on the closing day of the Clinic's sixth annual Medical Innovation Summit. 

Of particular interest to me is #4 – the use of multispectral imaging in pathology.  This is an active area of research in surgical pathology at many academic institutions.  These technologies offer the ability for increased throughput as well as enhanced diagnostic accuracy with the ability visualize directly numerous markers simultaneously.  With the use of spectal unmixing pathologists can not only discern what markers are expressed (i.e. presence of absence of a specific protein or cellular constituent) but to what degree or quantity they are present and perhaps most importantly the relationship of those proteins in a single cell. As opposed to looking at 4 different slides with 4 different stains and looking at tumor morphology this technology allows you to look at multiple stains on a single slide and analyze cellular morphology. 

One of the leading surgical pathologists in this field is Dr. Michael Feldman from the University of Pennsylvania.  He has lectured and written extensively on this subject.  His talk "Beyond Morphology" presented at the CAP Futurescape 2007 provides a nice review on the subject and the work he and his colleagues at CRI, Inc., one of the leading commercial manufacturers of systems and applications for this type of technology. 

Additional work by Dr. Feldman and others for specific types of cancers in-vitro as well as in-vivo with spectral and other light technologies justifies the placement of this technology as #4 on this list of medical innovations for 2009 and given the implication could be one of the most significant in surgical pathology in a decade.

Top 10 Medical Innovations for 2009

10. A national health information exchange. A comprehensive system of electronic health records that are portable and link consumers, doctors, hospitals and other health services providers. This computerized system has the potential to replace paper medical files with digital records that could increase quality of medical care and reduce its cost.

9. Doppler-guided uterine artery occlusion. An experimental procedure that uses sound waves and a clamp to kill fibroid tumors in the uterus. This procedure, which is being tested at the Clinic among other hospitals, could be an alternative to uterus removal for some women.

8. Integration of diffusion tensor imaging. A noninvasive technology that allows neuroscientists to create two- and three-dimensional, color images of the brain. Scientists use the images to locate nerve fiber bundles that must be preserved during brain surgery.

7. LESS and NOTES applications. Laparoendoscopic single-site surgery pairs minimally invasive surgical techniques with a single incision in the patient's belly button. Natural orifice transluminal endoscopic surgery is incision-less surgery through a natural orifice, such as the mouth, vagina or colon. Both techniques reduce infection rates and pain, and speed healing among patients.

6. New strategies for creating vaccines for avian flu. Scientists are working to engineer effective vaccines against killer bird viruses, such as H5N1. Current vaccines are formulated to match the flu virus as it mutates. A new approach uses a mock version of the virus to trigger an immune response that protects a person from the virus.

5. Percutaneous mitral valve regurgitation repair. Repairing a leaky mitral valve in the heart — the one-way valve that connects the left atrium to the left ventricle — from the inside out. A special clip is threaded through a catheter in the femoral artery in the groin to the heart. The clip is clamped on the center of the mitral valve "leaflets," holding them together and restoring normal blood flow.

4. Multispectral imaging systems . A time- and money-saving imaging system that when attached to a standard microscope enables pathologists to see up to four stained proteins at a time. Pathologists look at protein distributions to understand tumors and other abnormal tissues. Now, scientists must look at one of these proteins at a time.

3. Diaphragm pacing system. An electric device that stimulates the diaphragm to contract and relax, enabling paralyzed patients to breathe without the help of bulky mechanical ventilators. These devices can help paraplegics lead more normal lives and reduce rates of ventilator-induced pneumonia, which kills half of the people who get it. Synapse Biomedical Inc. in Oberlin makes a diaphragm pacing device called NeuRx DPS.

2. Warm organ perfusion device. Developed in Europe and being tested in the United States, this device pumps warm blood through a donor heart. The heart naturally starts beating and continues to beat until it is transplanted. This action keeps the heart from decaying.

1. Use of circulating tumor cell technology. A technology that measures tumor cells that circulate in the blood. Results can help doctors understand how a cancer is progressing and how to adjust treatments in patients who have repeat cancer.