Around 10 million people in Europe get diagnosed with dementia every year. NeuroMET has been a European research and innovation project (2016 – 2022) which has aimed at developing and improving measurement methods to help evaluate the effects of new treatments and drugs and enable earlier diagnosis. RISE has focused on developing quality-assured, traceable, and comparable methods for measuring the memory ability of patients. There are several testing tools used both clinically and in research today, but they lack reliability.

“The large measurement uncertainties in these tests mean that it is next to impossible to determine a person's memory ability at an early stage and in turn provide a reliable basis for diagnosing incipient dementia”, says Jeanette Melin, researcher at RISE and one of the participants in NeuroMET.

To be able to diagnose and make decisions about interventions as early as possible is one important reason for better reliability in memory measurements. Another reason is to be able to rule out dementia and instead identify other diseases or conditions. With better measurements of memory ability, it is also possible to better understand the dependency to biomarkers so that the impact of biomarkers on the disease can be evaluated in a better way. Biomarkers for dementia can, for example, be brain volume or the level of concentration of various proteins that influence the development of dementia. In this way, the research can contribute to the important task of developing future drugs that can slow the progress of dementia.

Valid and reliable measurement values

Together with Leslie Pendrill, researcher at RISE and one of the initiators of NeuroMET, Melin and her colleagues have developed a new way of measuring a patient’s memory ability, based on existing tests that are used clinically and in research. They have investigated which data from the existing tests can best be combined to both increase reliability and ensure validity, i.e., that the measurement is relevant and measures the memory ability and nothing else.

“The idea is that those who work clinically and in research should be able to continue using the existing tests but get measurement values that are significantly more reliable by using a conversion table. Optimally, all included tests are used together, but one or two tests can also be used individually, even though this increases the measurement uncertainty”, says Leslie Pendrill.

NeuroMET Memory Metric

The combination of test data is based on basic principles of quality-assured, traceable, and comparable measurements and is called the NeuroMET Memory Metric. The result is a method to better compare different people's results or a person's results over time to see how the disease progresses.

“The NeuroMET Memory Metric can be used already today, and in the coming years we will work to make it further available through adding more evaluations (with larger target groups and with other memory tests) and digitalization, with the aim of attracting more users, both clinically and in research”, says Jeanette Melin.

An operation to treat bladder cancer, transurethral resection, is a complicated procedure in many ways. A rigid metal tube is inserted through the urethra and burns away the cancer bit by bit. The waiting list for patients is usually long, and once the procedure can be performed, general anaesthesia or neuraxial anaesthesia is required. In many parts of the world, the patient is hospitalised for several days after the operation. The procedure is also costly, and the recurrence rate is high, which means the operation frequently needs to be repeated.

Unfortunately, many people can testify to the difficulties. Bladder cancer is the sixth most common form of cancer globally; in the US, 315,000 operations are performed every year, and in the five largest EU countries alone (including the UK), 360,000 people undergo the procedure annually. With a new technology being developed by a Swedish urologist and surgeon in her own company, Multi4, it is hoped the procedure will be simpler, less painful, and safer.

– “What we are developing now is a multi-tool so that a single instrument can be used to treat superficial bladder cancer,” says Miden Melle-Hannah, who hopes that the new procedure can be performed in Swedish hospitals within a few years. “The tool should only need to be inserted once, after which the procedure is carried out using automated and electrified technology. The urologist presses a button and the cancer is removed bit by bit, then transported out through the instrument itself into a special container. It will be a completely new way to perform a cancer procedure quickly and easily with a single instrument.”

Partners with RISE

The path from idea to clinical use is understandably neither easy nor fast. Many different studies must be carried out before human trials are possible. The hope is that as many problems as possible can be detected along the way and averted.

– “Multi4 contacted us at RISE first because they knew we could help with functional evaluation,” says Joakim Håkansson, who is an associate professor of biomedicine and works as a researcher and project manager at RISE. “This is often the case; someone knows or has heard that RISE knows part of the process and they get in touch with us. But following our initial contact, we realised we could become closer partners throughout the work from prototype to product on the market.”

– “I got in touch with RISE through our initial contact with Sahlgrenska,” says Melle-Hannah. “Before that, I didn’t know all that much about RISE, but I’m very pleased with the collaboration. At RISE, I met a competent team. The regulations for putting a new medical device on the market are very extensive, with many requirements. Therefore, it’s been great to have RISE as a partner.”

Research funding important for the process

The collaboration applied for and was granted research funding from Vinnova and Eurostar, which obviously helps in the process.

– “We have a clear division of work between Multi4, Sahlgrenska and RISE in how we drive the processes forward, and it’s important to engage in close dialogue so that any bottlenecks and challenges arising along the way can be overcome quickly and efficiently,” says Håkansson.

Faster procedure

There is evidently huge potential for improvements to current healthcare. Today, the procedure necessitates the involvement of many healthcare professionals during the operation, which is usually several hours long. The new instrument will enable the procedure to be carried out in around half an hour by a single urologist who can perform all the steps. Patients can be given a local anaesthetic and go home the same day.

– “We clearly see that our instrument could have many other uses,” says Melle-Hannah. “The vacuum technology we use to quickly take multiple tissue samples for diagnostics could be used for other cancers. For such a development, I believe the collaboration with RISE and Sahlgrenska can last.”

– “I know that many in the industry are not aware that RISE can take overall responsibility as a partner in medical technology development,” says Yalda Bogestål. “This is particularly important today when the regulations for the field are more extensive, and many companies need to do new tests and biological evaluation. At RISE, we hope to be able to help more Swedish companies, especially smaller and growing companies that may not have regulatory expertise, a contact network, or their own labs and test facilities.”

Bone grafting is a surgical procedure that uses transplanted bone to repair and rebuild damaged or diseased bones in the human body. The technology can be used virtually anywhere in the body. The surgeon needs to take either bone tissue from the patient - usually from the hips, legs or ribs - or use donated bone tissue. Both methods are, however, time-consuming, and it is not always easy to find a donor. 

A research project is being run to investigate brand-new ways of repairing damaged bone tissue without the need for a donor or transplants from other parts of the body. By combining 3D printing technology, nanotechnology, and stem cells, completely new bone tissue can be created in the body.

The technique involves printing 3D scaffolds – similar to the patient’s natural bones – from biomaterials. Live stem cells from the patient are added to the scaffold, which is then surgically inserted into the damaged area and stimulates the body’s natural bone healing processes.

“It’s a whole new way of repairing bone structure,” says Kristin Syverud, Head of Research at RISE PFI. “We use the body’s stem cells and make them grow into new bone structure. But it doesn’t happen by itself, they need a scaffold to grow on, and we make that from nanocellulose, which has shown great promise.”

Can also regenerate difficult structures

Using the 3D printer, the idea is to be able to even regenerate complicated bone structures. Based on X-rays of the patient, it is possible to see where there is missing or damaged bone, and the new method enables this precise area to be replaced. 

“The idea is to be able to print scaffolds in exactly the shape needed, which has not been especially easy to achieve before,” says Syverud. “Depending on the type of bone defect, this can be very difficult. We have collaborated with dentists and others in the project, and you can just imagine the incredibly complex bone structures we have in our mouths and jaws, for example.”

Ongoing research

Research is advancing, but before the technology can be put into widespread use in healthcare, a few steps must still be overcome. The cellulose must be safe to use, and it must have a surface structure on which the stem cells adhere, start dividing, and grow.

“And they should want to develop into bone cells. We have seen promising results for this; we can change the surface chemistry so that bone cells are specifically formed.”

Once the bone tissue has developed, the scaffold on which the cells have grown gradually degrades and disappears. Cellulose does not break down naturally in the human body, so it needs help to do so, but once the cellulose has degraded, it is converted into glucose – a sugar – which we can easily absorb.

"So it’s a completely unproblematic metabolite,” explains Syverud.

In the future, there will be several ways to use the technique, including for deep wounds or burns.

“The same procedure can be used to develop skin cells instead of bone tissue. It’s also possible that the same technique will be used to produce cartilage or other organs, but this is very complicated.”

Expertise at RISE

RISE has several environments with a high level of expertise in nanocellulose and its use in various applications.

"In Trondheim, we are researching nanocellulose for use in connection with creating new body tissues,” says Syverud.

In healthcare today, a computer can read an X-ray just as well as a doctor can – and even better in some cases. But the technology has many potential uses, such as automatic quality inspections or safety monitoring. However, before a computer vision system replaces a person, very high safety requirements must be met. Autonomous vehicles are one example.

"In many cases, the system is very good at making the right decisions quickly and is sometimes better than a human being at driving a car,” says Aleksis Pirinen, Senior Researcher in Machine Learning and Computer Vision. “Yet we still we don’t feel that the technology is mature, even though it could already, to some extent, lead to fewer deaths on the roads.”

Various and high thresholds for use

For some computer vision applications, there are ready-to-use AI models, such as for X-ray images where a computer has learned to distinguish between an intact bone and one with a fracture. But for those seeking to develop something new and specific to their business, a number of steps must be implemented.

“A fundamental point is to have training data that your AI model should train on,” says Pirinen. “For example, if you want the system to recognise agricultural plant diseases, you need pictures of healthy plants as well as diseased plants.”

And once you have your training data, you need to tell the system what it depicts by means of so-called annotations, or information about what each image contains.

For those wanting to implement or develop computer vision technology in their organisation, RISE can be a partner for teaching, collaboration, or research.

“We have many research projects through which we can demonstrate what can be done with the data and to meet the needs of the partner,” says Mogren.

Several ethical aspects

An ethical dilemma related to computer vision is bias, which is sometimes unconsciously built into the system by those who trained it. Among other problems, there have been instances where the system does not read dark-skinned faces as well as it does for light-skinned faces.

“This is of course extremely problematic, you have to work actively to minimise this kind of bias in your models,” says Mogren.

“One way could be ensuring greater diversity among those who develop the models,” says Pirinen.

Another ethical dilemma, often highlighted in the media, is the risk of ‘deepfakes’. Not only can computer vision learn to understand what it sees, but it can also create images.

“With the right skills, very realistic images and videos can be made,” cautions Pirinen. “This is something that will need to be tackled in the future.”

“As with all technology, it can be used for both good and evil,” adds Mogren. Positive uses for images generated by the systems include digital twins, which can be used in research to perform tests in a very realistic simulated environment, and images that show the potential effects of upcoming climate disasters.

“It’s a way to demonstrate how powerful these systems are, and how there are both risks and positive uses.”

Retinal imaging and weed control

Two computer vision applications that RISE helped to develop are retinal imaging as a form of drug testing, and new possibilities for weed control.

“We worked with data and algorithms to find weeds, then another operator developed a robot that seeks and destroys them using a small laser,” says Mogren.

Computer vision is an emerging technology, and we have not yet seen all the application areas for which the technology can be useful.

“Autonomous vehicles and all types of driver assistance systems are also arenas where this technology is incredibly useful. I would say that computer vision has an abundance of benefits. There are extremely wide areas of application that are only limited by our imaginations,” concludes Mogren.