From AI to Robotics: The Next Frontier in Neuro-Interventional Radiology

Shahid Akhter, Consultant Editor, FEHealthcare, talks to Dr. Santhosh Joseph, Sr. Consultant & Clinical Lead, Dept of Neuro Interventional Radiology, KIMSHEALTH, Trivandrum, on how AI, robotics, and imaging are redefining neuro-interventional radiology in India.

 

How has the integration of AI, robotics, and advanced imaging technologies improved procedural accuracy and diagnostic capabilities in NIR?

The integration of AI, robotics, and advanced imaging technologies has significantly improved the diagnostic accuracy. Using AI algorithms, such as the detection of ischemic penumbra with rapid software, has significantly reduced the time of interpretation of viable vs. non-viable tissues on a multitude of images taken using perfusion CT. These images, if manually interpreted, would result in errors, interpersonal variations, and considerable time. Several software programs are now available for the same. Using robotics (Corindus NV), intervention procedures can be carried out, outside the hospital environment, in different parts of the country or even in intercontinental regions. The accuracy of placement of devices is much better than that of direct intervention. There are several software programs available that can be integrated with the 3D workstation so that in vitro deployment of the devices, the accuracy of deployment, and the efficacy of the treatment can be detected before the procedure. Flow modelling before and after deployment of the devices can easily predict the outcome of the treatment, and additional treatment can be planned prior to or during the procedure to obtain a higher degree of success rate (MAFA).

What are the key demographic trends among patients undergoing neurointerventional procedures in India?

Demographically, most of the patients undergoing endovascular procedures are above the fourth decade, which is true all over the world, including India. Of course, more and more people are coming down with strokes at a younger age, starting even in their second and third decades, maybe due to lifestyle factors. There are no major or special gender differences.A small portion of patients are in childhood, and even at birth.

How widely are advanced NIR techniques being adopted in rural areas of India, and what are the major barriers to their implementation?

Neuro-interventional procedures are rarely being adopted in rural areas because of the lack of diagnostic tools such as CT scans, MRIs, PET CTs, and so on. There is also a scarcity of digital angiography systems and the necessary hardware and trained personnel in rural settings. The major barriers are a lack of awareness of the sophisticated procedures and economic barriers. Also, awareness should be created about the existing health facilities so that the patients can be transported to the appropriate centers, where facilities are available. Lack of trained paramedical staff and transportation personnel is also a hindrance. As time is crucial, the speed of action in diagnosing and transporting the patient to a higher center is extremely important.

What do you foresee as the next major breakthrough in neurointerventional radiology over the next 3 to 5 years?

Interventional radiological procedures are undergoing rapid changes. More and more newer devices are being added to the armamentarium, and procedures are made simpler because of the safer and finer devices available in the market. This will also reduce the learning curve and can be used among interventional neuroradiologists. Robotics and tele-robotics will make these available to every person in the world using the best expertise in the world. Imaging 5D or 6D angiography offers an accurate understanding of complex AVM with compartments draining the artery and veins, whereby treatment strategies could be modified. This newer equipment reduces the radiation dose delivered to the patient, thereby increasing the safety and reducing the procedure time.

How does the cost of advanced NIR procedures compare with the clinical outcomes they deliver, especially in the Indian healthcare context?

The cost of the interventional neuro procedures is relatively high when compared with the surgical procedures. Currently, with the wide availability of devices and the increased number of procedures, we should reach a stage in the next 5 to 10 years where the cost will come down or may be comparable to or even less than that of surgery. Further, since there is no opening of the skull, the recovery time is less, and the patient can get back to work or to their routine much faster than with surgery, thereby reducing hospital stay.