Hidden haemodynamics: A Physics-InfOrmed, real-time recoNstruction framEwork for haEmodynamic virtual pRototyping and clinical support (PIONEER)

Personalising care, i.e. tailoring therapeutic recommendations to people's individual health needs, has always been a clinicians' goal throughout the history of medicine. But never before has it been possible to design interventions and to predict how our bodies will respond to those. New possibilities are now emerging as we bring together novel approaches, such as state-of-the-art imaging and modelling and simulation.
The NHS Long Term Plan identifies cardiovascular disease as a clinical priority and the single biggest condition where lives can be saved by the NHS over the next 10 years. There are currently over 43000 often life-saving vascular interventions p/year in England alone, predicted to increase due to an ageing population and rise in co-morbidities. Many of these interventions require surgery and/or permanent and personalised vascular implants. Vascular surgeons rely on superb skill and flair to perform some of the most complex (and life-critical) interventions; patients, on the other hand, rely on these interventions being safe or high-performing, for a lifetime. But how do we know that this will be the case? That these interventions are optimal?
Getting the right intervention (often, surgical) to the right patient, at the right time, i.e. precision vascular surgery, has until now, been an unachievable goal. To realise this goal, we require transformative engineering technologies, fundamentally different from those used today. For the vascular surgery of the future to become a reality, we need pioneering work able to predict the future outcome of an individualised vascular intervention with an acceptable level of realism, fast enough to allow the exploration of multiple possibilities in short periods of time, and trustworthy enough such that they elicit trust and confidence from clinical practitioners.
Blood flow (haemodynamics) plays a pivotal role in the initiation and progression of most vascular conditions and the clinical outcomes of interventions. However, hemodynamic information is not readily available in routine clinical practice -despite advances in medical imaging- where a variety of imaging modalities are used routinely. More crucially, imaging data can only give us information about the present, not the future; they cannot tell us what the outcome of any given -often personalised- intervention will be. Here is a case where engineering tools can make a real difference by providing blood flow information for vascular diseases, that cannot be measured in vivo and more importantly, by creating computer models of potential interventions, and their outcomes. By fusing computational blood flow models and imaging data we can make a real breakthrough in clinical pre-operative planning and personalise treatment.
In PIONEER we plan to develop the most sophisticated, physics-driven computational tools that will extract, in real-time, accurate unsteady and three-dimensional hemodynamic information (velocity and pressure) from routinely used vascular imaging data. This information will be used for haemodynamic virtual prototyping of personalised cardiovascular interventions and tailoring of cardiovascular devices. The work will enable a fundamental step forward towards precision vascular surgery and will provide expert support for vascular surgeons in their decision-making process, leading to a dramatic improvement in the management of individual patients' risk. To catalyse this vision, we will work synergistically with three top hospitals in the country (Royal Free Hospital, Barts Hospital and GOSH), two patient groups (AVM Butterfly Charity and Aortic Awareness UK) and a leading medical device company, Terumo Aortic. Together, we will firstly create a proof of concept that will pave the way to introduce our ground-breaking technology in clinical and manufacturing workflows.