Awarded PIHC Projects

APPLYING TECHNOLOGY IN HEALTHCARE VOUCHERS 

HIRAM – Hybrid Interventions using Robotically-Actuated Magnets
Minimally-invasive magnetic surgeries have been a prominent emerging technological alternative to open surgeries in the search to reduce patient trauma and recovery time. At the University of Twente, in collaboration with multiple industrial and clinical partners, a novel minimally-invasive magnetic surgical system has been developed. Experimental research has shown promising results: Not only could this system benefit patients, but also the surgeons and the associated hospitals. To realize the full clinical potential of this system, this project would encompass the assessment of its feasibility within a hybrid operating theatre. It will be tested during pre-clinical trials aimed at cardiovascular interventions.
Dr. ir. Christoff Heunis (UT), Prof. dr. Sarthak Misra (UT), Prof. dr. Bob Geelkerken (MST), Dr. Theo Menting (MST), Dr. Rombout Kruse (ZGT), Bryan Wermelink, MSc (UT)

Automated Detection of Epileptiform Discharges Using Artificial Intelligence (AI4EPI)
Epileptiform discharges in the electroencephalogram (EEG) reflect an increased likelihood of seizures and are routinely inspected by visual analysis. This is time-consuming and human error is not uncommon, in part because medical experts are not always available. This motivates development of approaches towards automating EEG analysis. We aim to automate detection of epileptiform discharges using unsupervised (deep/machine) learning, which does not require labelled data. This allows “learning” from the huge amount data already available in the clinic. We expect to realize AI-systems with performance at least on par with human experts, for reliable, efficient and more cost-effective diagnostics for epilepsy.
Prof. dr. Michel van Putten (MST-UT), Dr. Maryam Amir Haeri (UT), Dr. Stéphanie van den Berg (UT)

WAIT&WORK: VR-supported e-care path in the waiting list for chronic pain
1 in 5 adults experience chronic pain. Waiting lists for treatment are long and treatment is ineffective. VR could be a new treatment method, but it is not used in clinical practice. It is also still unknown which (psychological) interventions are effective in VR for chronic pain. In this project we develop an innovative, hybrid eHealth care-path for chronic pain. VR is used in the waiting room, in the patient's home. We investigate which mechanisms of action of this virtual e-Health contribute to manage pain, in order to personalize treatment and move towards an effective, new approach to chronic pain.
Dr. ir. Monique Tabak (UT), Dr. Lieke Heesink (UT), Remko Ter Riet (ZGT), Aletta Koster (ZGT), Dr. Nelson Monteiro de Oliveira (ZGT), Dr. Gert-Jan Prosman (UT; Other), Aline Beernink-Heurman (DZ), Drs. Ina Flierman (Roessingh Centrum voor Revalidatie), Leonie Oolbekkink (DZ), Milco Schildkamp (Roessingh Arbeid, Roessingh Pijnrevalidatie)

Virtual prepared: realistic preoperative education for bariatric surgery using Virtual Reality
How do we ensure that patients eligible for bariatric surgery are well prepared for life after surgery? Currently, preparation of patients consists of providing information. This however proofs insufficient to fully grasp the consequences of this operation on behavior and challenges in daily life. As a result, patients can experience difficulties integrating their new ‘self’ in their daily life, maintaining lifestyle changes and coping with peer pressure. In this project we explore technological solutions that enable patients to experience indepth post-surgery life as to improve presurgical preparation.
Dr. Tim Verhagen (ZGT), Dr. Joanneke van der Nagel (UT), Dr. Josien Timmerman (ZGT), Nanda de Jong (ZGT), Matthijs van Veen (Saxion), Dr. Elke ter Huurne (Saxion), Dr. Marloes Postel (Saxion)

EYE IN THE SKY
Descemet Mebrane Endothelial Keratoplasty (DMEK) corneal transplantation can have significant visual improvements in endothelial dystrophy patients, although the risk of postoperative graft detachtment with corresponding need for rebubbling should be assessed. Older recipient age is reported to be related to a higher rebubbling rate. A supine posture after the operation is thought to be important for succes. The relation between transplant detachment and the abbility to maintain a supine position in the first 24 hours after the operation will be investigated.
Dr. Marjolijn Bartels (DZ), Dr.ir. Bert-Jan van Beijnum (UT), Drs T.M. Vaessen (DZ), A. Buschers (DZ), Prof.dr.ir. Peter Veltink (UT)

Live 3D microsurgery: Remote care and distant supervision using online connection and live 3D view from the operating microscope
Operating microscopes are essential tools in microsurgery for a detailed and stereoscopic view. Despite many developments of the operating microscopes, it is currently not yet possible to share stereoscopic images outside the operating room. This project focuses on the development of a 3D viewer based on a smartphone, tablet or computer screen in combination with a secure software platform that makes it possible to view 3D-microscopic (ear) surgery in real time outside the operating room anywhere in the world. This creates the possibility of consulting experts, supervising operations from a distance and facilitating and improving education.
Dr. Pauline van Kempen (DZ), Prof. dr. ir. Ruud Verdaasdonk (UT), Dr. Joeri Buwalda (DZ), Dr. Steven Bom (DZ)

TECHNOLOGICAL PIONEERING IN HEALTHCARE VOUCHERS

Artificial intelligence based data analysis with two dimensional perfusion angiography imaging in peripheral arterial disease
The main reasons to perform revascularization procedures in patients with peripheral arterial disease, is to improve tissue perfusion of the lower leg and foot, to avoid tissue loss. Success of revascularization assessment is based on peroperative digital subtraction angiography, which are analysed qualitatively by the vascular interventionist peroperatively, and are consequently prone to subjective interpretation. Therefore, clinical outcomes after a revascularization procedure are still unpredictable. There is a need for real-time, objective, and reliable peroperative quantitative angiography analysis in the search for a threshold to predict clinical outcomes. This will support the interventionist to make peroperative decisions, improving clinical outcomes.
Prof. dr. Bob Geelkerken (UT), Lennard van Karnenbeek, BSc (UT), Bryan Wermelink, MSc (UT), Dr. Robbert Meerwaldt (MST), Dr. Rombout Kruse (ZGT), Dr. Jelmer Wolterink (UT), A. Rebet (GE Healthcare), Maxime Taron (GE Healthcare), Yves Trousset (GE Healthcare), Dr. Marieke Haalboom (MST), Prof. dr. Srirang Manohar (UT)

ACHILLES - Advanced CHild friendly IV Line Lock Early warning Sleeve
Intravenous infusion is common practice within the pediatric population. Insertion of an intravenous access (IV) is technically difficult in children - and stressful. Subsequent securing of the IV requires immobilization and wrapping of the limb. Despite these precautions, IV’s often dislocate, which can lead to tissue damage. Repeated insertions can traumatize children, just like observing the IV into their hand. Our solution is a smart sleeve that improves securance, camouflages the IV line for children while allowing for rapid visual inspection by healthcare workers. Furthermore, an integrated warning system indicates early IV dysfunction.
Dr. ir. Jorrit de Jong (Saxion), Dr. ir. Javier Ferreira-Gonzalez (Saxion), MA Hellen van Rees (Saxion), Dr. Boony Thio (MST), Drs. Vera Hengeveld (MST), Drs. Matienne van der Kamp (MST), Drs. Monique Gorissen (DZ), K. Kamphorst (DZ)

Infrastructure for Cardiovascular Treatment using Cinically-Relevant Applied Microrobotics
Challenges associated with the treatment of vascular diseases can be overcome using microrobotic agents, leading to safer and more effective therapy. Nevertheless, no infrastructure for clinical deployment of microrobots exists. The goal of ICECReAM is to create a catheter employing localized magnetic actuation for non-contact treatment of unstable atherosclerotic plaque using functionalized microparticles. This way, the stabilization of plaque will be achieved without the risks of cerebrovascular incidents, associated with current state-of-the-art treatment. The technology developed in ICECReAM will open up a realistic route towards clinical use of microrobotic agents, setting up a foundation for numerous novel treatment protocols.
Dr. Jakub Sikorski (UT), Dr. Roland Beuk (MST), Prof. dr. Sarthak Misra (UT), Dr. ir. Jeroen Rouwkema (UT), Vasileios Trikalitis (UT) 

Data-driven multimodal decision support for the prediction of complications following esophageal surgery
Treatment of esophageal cancer requires major surgery. Postoperative complications such as anastomotic leakage and pneumonia occur frequently (50%) and are often life-threatening (mortality 11%). Early recognition of a complication is crucial for speedy recovery. An attending physician still must base decisions on experience, gained by interpretation of bedside information, vital parameters, and diagnostics. Decision support with machine learning can forge a breakthrough, allowing a faster and more adequate response to emerging complications. Therefore, we investigate whether simultaneous use of multiple data streams (vitals, laboratory tests, chest images, health status, pain perception and mobility) leads to a better prediction of complications.
Dr. Ewout Kouwenhoven (ZGT), Dr. Mannes Poel (UT), Ing. Jeroen Geerdink (ZGT), Dr. Julia Mikhal (ZGT)

The Bath Mat: Technology for early detection of diabetic foot ulcers in the home setting
Measuring foot temperature is a promising tool in the prevention of diabetic foot ulcers. We do away with the limitations of existing methods: we will develop technology that measures the temperature distribution of both the plantar region and the dorsum of the foot, and imposes minimal requirements on the subject: being barefoot now and then in the bathroom or at the bedside is sufficient. The true innovation cannot be disclosed here. In this project, we will develop a prototype, which we will test together with patients to narrow down further requirements for the technique and integration of the device in clinical practice.
Dr. Kilian Kappert (ZGT), Prof. dr. ir. Wiendelt Steenbergen (UT), Dr. Rombout Kruse (ZGT), Erik Manning (ZGT)

Improving free flap transplantations with the use of handheld laser speckle perfusion imaging
Necrosis is a serious complication in breast cancer surgery with reconstruction using autologous transplanted tissues. Necrosis is caused by a low blood perfusion of the transplanted tissue. Technology is needed to measure perfusion in a real-time and objective manner so surgical strategies can be adjusted directly, preventing complicated sequels. In this project, we investigate if laser speckle is a candidate for this. We will use the wireless handheld system developed by the University of Twente within ZGT during surgery. Eventually we hope to achieve a better final outcome for the patient, while saving costs and effort associated with complications.
Dr. Hinne Rakhorst (ZGT), Dr. Daniel Evers (ZGT), Prof.dr. ir. Wiendelt Steenbergen (UT) 

A new glucose sensor for the artificial pancreas
One out of 14 persons in the Netherlands suffers from diabetes mellitus. They actively have to keep their blood glucose level within a certain range with insulin and food-intake to prevent complications. In close collaboration with Inreda Diabetic, manufacturer of the artificial pancreas (AP), we aim to develop an innovative glucose sensor for their device that is faster, more accurate and can be used for a longer time. This enables better regulation of the glucose levels and reduces the chance of additional complications. In addition, acceptance of the AP and sensors will be researched in adults and children with diabetes.
Dr. Martin Bennink (Saxion), Dr. Goos Laverman (ZGT,UT), Drs. Kilian Kappert (ZGT),
Drs. Renske Rijlaarsdam (ZGT), Drs. Esther Willigenburg-Jansen (ZGT),
Robin Koops (Inreda Diabtetic BV), Mikael Boulay (Inreda Diabetic BV),
Dr. Aurel Ymeti (Saxion)

Automated skin prick test for allergy sensitization assessment: development of a user-friendly, reproducible and decentralized method using AI algorithms and 3D photography.
For the diagnosis of allergy sensitization is measured by means of a skin prick test, in which the allergic skin reaction is manually read by determining the size of the squeeze. This project focuses on the development of a user-friendly objective method that accurately and reproducibly determines the surface of the squat. By using segmentation techniques and Artificial Intelligence (AI) algorithms and by examining the added value of 3D photography, the sensitization can be determined. Using a smartphone application, a skin prick test could also be reliably performed by the general practitioner or general pediatrician to achieve a good decentralization. 
Dr. Joyce Faber (DZ), Prof.dr.ir. Ruud Verdaasdonk (UT), Drs. Monique Gorissen (DZ), Dr. Boony Thio (MST), Drs. Danielle van Bommel-Slee (ZGT), Rob van Doremalen (DZ), Dr. Françoise Siepel (UT), Dr. Maaike Koenrades (MST)

Phenotyping glucose variability for a better life with type 1 diabetes
Development of complications in type 1-diabetes appears not only related with mean high blood glucose levels but also with unnoticed fluctuations, which may display considerable between patient-variability. The recent availability of continuous glucose monitoring (CGM) data in most patients enables to use new parameters, including “Time In Range” and glucose-variability. Here, we create a unique CGM-database, define and validate the new parameters and investigate the relation between glucose fluctuations and diabetes complications.
This project results in a paradigm-shift in the follow-up of glucose regulation and paves the way for personalized treatment: A better life with diabetes and less complications.
Dr. Goos Laverman (ZGT,UT), Thomas Urgert (ZGT), Dr.ir. Bert-Jan van Beijnum (UT), Drs. Kilian Kappert (ZGT), Ing. Jeroen Geerdink (ZGT), Prof.dr. Miriam Vollenbroek-Hutten (UT, ZGT)

Artificial inTelligence-empowered endo-ultrasonographic assessment of bowel wall infiltration in early colorectal cancer (a Tempo study)
Since the introduction of the screening of colorectal cancer, early cancer stages with opportunity for local resection are frequently detected. Successful endoscopic resection is only possible if the tumor does not extend into the muscle layer of the bowel. This infiltration depth is judged by surface characteristics, but this judgment is not very reliable in case of deeper infiltration. Endoscopic ultrasound is the only way to visualize the relationship between the muscle layer and the tumor. However, only experienced endosonographists reach acceptable accuracy. This project investigates if automated image processing and recognition will enhance reproducibility and accuracy of this technique.
Dr. Frank ter Borg (DZ), Dr. Jelmer Wolterink (UT)

Balanced Rehabilitation after an Ankle Fracture Operation (The BRAFO study)
Rehabilitation after operation of an ankle fracture occurs mostly at home. In current practice weight bearing of the affected side starts six weeks after surgery. There is clinical evidence though showing that this may be started earlier, however, only under the condition that patients are closely monitored during daily life. At this moment there is no suitable ambulatory measurement system with which we can monitor load, gait patterns and balance in these patients during daily life and no knowledge exists regarding these parameters in the target group. In this project a robust and user-friendly measurement system is being developed that makes this possible. The system will be technically validated. A pilot study, in which this measurement system will be used to monitor patients deploying partial weight-bearing in week 3 until 6 after the ankle surgery, will provide the first insights into the user-friendliness, applicability and clinical possibilities of this new measurement system.
Dr. Han Hegeman (ZGT,UT), Dr. Bert-Jan van Beijnum (UT), Hans Faessen (ZGT), Ellis Folbert (ZGT), Prof.dr. Jaap Buurke (UT, RRD), Prof.dr. Miriam Vollenbroek (ZGT, UT), Prof.dr.ir. Peter Veltink (UT)

Risk assessment in ischemic stroke by photoacoustic quantification of carotid plaque (in)stability
Worldwide vascular diseases cause 17.8 million deaths annually, partly from ischemic stroke (23%) caused by unstable thrombogenic atherosclerotic vascular wall lesions in the carotid artery. The choice for intervention is determined by the degree of the narrowing of the carotid artery. The degree of carotid plaque instability is barely included in the decision-making process. The Number-Neededto-Treat (NNT) is 6 and the Number-Needed-to-Harm (NNH) is 0.3. Better patient selection, including taking plaque instability in decision-making, will contribute to meaningful care. We aim to optimize a handheld multispectral photoacoustic system and examine carotid plaque (in)stability.
Dr. Francis Kalloor Joseph (UT), Prof.dr.ir. Wiendelt Steenbergen (UT), Prof.dr. Bob Geelkerken (MST,UT), Prof.dr. Michel Reijnen (UT), Dr. Renate Arntz (MST), Prof. Riemer Slart (UT), Dr. Ruchi Bansal (UT), Dr. Mithun Kuniyil Ajith Singh (Cyberdyne Inc)

MR lymphography and magnetic sentinel lymph node biopsy in melanoma patients
Melanoma of the skin has a strong tendency to metastasize. Current-standard-of-care treatment is focused on dissection of the primary tumour and assessment of nodal status by an invasive surgical procedure: sentinel lymph node biopsy (SLNB). However, 84% of dissected LNs are negative for metastases. With this pilot we will concentrate on the improvement of care: developing a MR lymphography protocol for preoperative patient stratification into SLNB, and improving medical devices for perioperative LN detection. Consequently, this study will pave the way towards larger clinical trials to improve the melanoma treatment in terms of improved health outcomes and reduced healthcare costs.
Dr.ir. Lejla Alic (UT), Dr. Anneriet Dassen (MST), Drs. Anke Christenhusz (UT), Ir. Jan Leerkotte (MST), Dr. Casper Smit (MST), Ir. Marjolein Hilgerink (ZGT), Dr. Noortje van der Bijl (MST), Dr.ir. Frank Simonis (UT) Remco Liefers (UT), Ir. Erik Krooshoop (UT), Mariska Schreven-Stellaard (Labpon)

Home-based rehabilitation for children with oncologic disorders by use of a care robot
The physical fitness of children with cancer drops sharply during their treatment. Contributing to this fall in fitness is, besides the disease and treatment itself, their physical inactivity. Normally children maintain their fitness through sports and play with peers, however their vulnerability compromises social interaction. A caring little robot, could be a playful buddy that can induce activity and simultaneously monitor reactivation by connecting to wearable sensors. In this pilot study we will investigate if a caring robot is a feasible tool to reactivate children with cancer at a distance. 
Drs. Vera Hengeveld (MST), Dr Pieter van Lierop (MST), Drs. Wouter Quak (DZ), Drs. Matienne van der Kamp (MST), Dr.ir. Monique Tabak (UT), Dr. Joyce Faber (DZ), Drs. Ina Flierman (Roessingh Centrum voor Revalidatie)

Photoacoustic breast tomography: Towards monitoring of neoadjuvant chemotherapy response
A state-of-the-art photoacoustic breast imager has been developed under the coordination of the University of Twente, in a European collaboration with universities, companies and the regional hospitals. This imager will allow us to accurately analyse tumor vascularity, tissue perfusion and oxygenation in breast tumors, which are known to be highly suitable parameters for response evaluation in neo-adjuvant-chemotherapy (NAC). In this PIHC project we will investigate the diagnostic accuracy of the imager, and for the first time lay the foundation for a clinical study on the use of photoacoustics for the evaluation of NAC.
Prof.dr. Srirang Manohar (UT), Dr. Jeroen Veltman (ZGT,UT), Dr. Ester Siemerink (ZGT), Dr. Margreet Van der Schaaf (MST), Prof.dr. Lioe-Fee De Geus-Oei (UT), Dr. Machteld Wymenga (MST), Dr. Daniëlle de Leeuw (ZGT), Maura Dantuma (UT), R. Bulthuis (UT), Saskia Aarnink (MST), Dr. Anneriet Dassen (MST)

Ultrasonic therapeutic film
Every year 500.000 Dutch patients suffer from chronic wounds. These are slow healing wounds, commonly as a result of underlying diseases. The most common are high pressure, lower leg and diabetic foot ulcers, which even with the best care can result in amputation or eventually death. Ultrasonic waves interact with cells and tissue through pressure oscillations, promoting wound healing even in case of reduced oxygen delivery to the tissue. This project will bring together UT researchers and clinicians to find the best way to accelerate and stimulate healing in chronic wounds with ultrasonic means. 
Dr. Pep Canyelles Pericas (UT), Drs. Kilian Kappert (ZGT), Dr. Rombout Kruse (ZGT), Dr. David Fernandez Rivas (UT), Prof.dr.ir. Michel Versluis (UT), Prof.dr.ir. Albert van den Berg (UT), Semme Molenaar, (NovelT)

Antimicrobial surfaces in the healthcare setting
Global threat of antimicrobial resistance is calling out urgently for novel antimicrobial strategies. Current technologies rely mostly on biocides which in the long-run are prone to antimicrobial resistance. Novel solutions to reduce spreading of infections and surface contamination must urgently reach out to the healthcare sector. Micro- and nano-structured surfaces represent a promising solution. However, there is no clear strategy for applying these in medical care. That is why we want to research new materials with antibiotic properties applied to metal medical implants.
Dr. Arturo Susarrey-Arce (UT), Drs. Laura Vargas (UT), Prof. dr. Han Gardeniers (UT), Prof. dr. Martin Bennink (Saxion), Dr. Jorm Nellensteijn (MST), Dr. Gerard Linssen (ZGT), Dr. Wiebe Verra (MST), Dr. Maarten Schijffelen (MST)

Preoperative 3D planning and printing for anterior closing-wedge osteotomy after ACL rupture for posterior tibial slope correction: 3D-correct
Young sports people frequently tear their anterior cruciate ligament (ACL), requiring ACL reconstruction. However, ACL re-rupture often occurs, and most patients suffer from posttraumatic osteoarthritis (OA). Among the causes of re-rupture and post traumatic OA there is knee instability, caused by excessive tibial slope. Surgical tibial slope correction can be done before ACL reconstruction, but the optimal slope may differ for every patient. Therefore, depending on anatomy, the current study aims at applying a patient specific musculoskeletal model to surgically plan the optimal slope correction. which could be achieved safely and more accurately by means of 3D printed cutting guides.
Dr. ir. Marco Marra (UT), Femke Schröder MSc (OCON), MD Roy Hoogeslag (OCON)

Balancing unicompartmental knee arthroplasty: Development of a 3D printed feeler gauge with embedded pressure sensor
Unicompartmental knee arthroplasty is an effective treatment for isolated medial osteoarthritis of the knee. During surgery, the joint surfaces are replaced by two metal components, and a plastic insert with a variable thickness is inserted into the joint space. The orthopedic surgeon uses a feeler gauge to evaluate whether this space is not too tight or too loose. The aim of this feasibility study is to develop a 3D-printed feeler gauge with an inbuilt pressure sensor that enables a more accurate placement of the prosthesis. This may result in better clinical outcomes, longer survival of the prosthesis, and fewer complications.
Dr. Hans-Peter van Jonbergen (DZ), Prof. dr. ir. Gijs Krijnen (UT)

Healing wounds using phototherapy
Chronic wounds - that do not heal in months or even years - represents a major medical challenge because of traumatic injuries, the rising prevalence of chronic wounds such as diabetic ulcers and aging populations with diminished wound healing ability. Current treatment options involve different types of dressings that mainly protect the wound from pathogenic infections. However, these strategies are insufficient and rely on slow and passive healing processes. In this project, we are initiating a collaboration between the UT, MST and ZGT to validate phototherapy using a hand-held device for the treatment of wounds at the hospitals or home.
Dr. Ruchi Bansal (UT), Dr. Robbert Meerwaldt (MST), Dr. Marieke Haalboom (MST), Dr. Sjef van Baal (ZGT), Dr. Rombout Kruse (ZGT), Drs. Harm Jaap Smit (iCap BV)

PRedicting Efficacy of neuromoDulation in epilepsY with ConTinuous EEG: PREDYCT
In patients with epilepsy who cannot be treated with medication, neuromodulation (vagus nerve or deep brain stimulation) can significantly reduce the seizure frequency. However, approximately 30-40% of patients who receive this treatment do not report any benefit. This is not only disappointing for the patient, but also associated with significant healthcare costs (€ 25.000 per patient). We aim to identify patients who will and who will not benefit from neuromodulation by long-term (2-4 months) measurement of brain function using a minimal invasive subcutaneous electrode. Using machine learning (AI), we aim to identify EEG biomarkers to predict effectiveness of neuromodulation.
Prof. dr. ir. Michel van Putten (UT), Kuan Kho MD (MST), Dr. Marleen Tjepkema (MST)

Assessment of the microcirculation using photoacoustic imaging in patients with peripheral arterial occlusive disease
End stage Peripheral Arterial Occlusive Disease (PAOD) leads to severe claudication and tissue loss at the foot. Here the loss of macro- and microcirculation plays a major role. To prevent tissue loss, patients are preferably revascularized endovascularly under fluoroscopy. The macrocirculation can be well assessed under fluoroscopy. A major shortcoming is the assessment of the microcirculation. To enable peroperative assessment of the microcirculation, we want to study and optimize the Cyberdyne Acoustic X photoacoustic system and assess if this system can quantify the microcirculation.
Prof. dr. Bob Geelkerken (MST), Prof. dr. ir. Wiendelt Steenbergen (UT), Bryan Wermelink MSc (UT), Dr. Sjef van Baal (ZGT), Dr. Robbert Meerwaldt (MST), Dr. Marjolein Brusse-Keizer (MST), dr. Mithun Kuniyil Ajith Singh (Cyberdyne Inc)

Preferral
Of all Dutch adults, 1 in 5 has musculoskeletal pain. More than 50% of these people have limited functioning. Experienced disease burden can be reduced by starting an appropriate treatment as early as possible. However, it appears that more than 30% of the patients are referred back to the general practitioner (GP) with a rereferral to somewhere else. This results in an inefficient care path. The objective of this project is to optimize existing care pathways and referrals in 1st, 2nd and 3rd care based on artificial intelligence, leading to a proof-of-concept decision support system for the GP and paramedic.
Dr.ir. Wendy Oude Nijeweme - d'Hollosy (UT), Dr. Gert-Jan Prosman (UT), Dr. Annemieke Konijnendijk (UT), Dr. Mannes Poel (UT), Dr. Remko Soer (Saxion), Drs. Jose Broeks (ZGT), Dr. N.P. Monteiro de Oliveira (ZGT), Prof. dr. Miriam Vollenbroek-Hutten (ZGT)

Data science and or scheduling: The perfect fit
The operating room (OR) schedule significantly impacts the performance of the OR and many interrelated departments. A critical component in OR scheduling is predicting surgery durations. These predictions are frequently incorrect, causing expensive OR idle time, OR overtime, and surgery cancellations. We plan to leverage recent advancements in machine learning to develop a model that generates accurate predictions of surgery duration. Subsequently, we will develop an algorithm that automatically generates optimal OR schedules – a process that is currently mainly done manually. Our algorithm will shorten patient wait times and waitlists, reduce workload, and result in smoother OR programs.
Dr.ir. Aleida Braaksma (UT), Dr. Marloes Vermeer (ZGT), Marijn Hoek (ZGT), Drs. Johan Raymakers (ZGT), Prof. dr. Richard Boucherie (UT)

Is the chemo working 2.0: Continuous tumor response evaluation with a liquid biopsy-based lab-on-a-chip system
Chemotherapy is an expensive therapy that places a high burden on the patient. Currently, the patient response to therapy is monitored by imaging techniques. These methods are slow and do not always give clear and accurate information. In contrast, liquid biopsies can provide more accurate information in a shorter period of time. By measuring specific biomarkers in blood, the status of a patient can be evaluated quickly, and more frequently. This approach also fully supports the concept of personalized medicine by facilitating the identification of patient-specific biomarkers. The novel technology discussed here uses nano-electrodes to detect tumorspecific biomarkers in blood with unprecedented accuracy.
Prof. Séverine Le Gac (UT), Dr. Alex Imholz (DZ), Prof. dr. ir. Wilfred van der Wiel (UT)

Real-time identification of the source of exacerbation
COPD is predicted to become the third leading cause of death in 2030. COPD patients often endure exacerbations. Although the cause of exacerbations is bacterial in nature in only 20% of cases, 80% of patients receive antibiotics as part of the treatment. The reason for this discrepancy is the dependence of diagnostics tools on culturing the bacteria, which can take up to five days. The proposed technology is composed of an integrated system for the electrochemical detection of individual bacteria and for predicting each patient’s response to antibiotics. This allows to take a proper decision directly.
Prof. dr. ir. Wilfred van der Wiel (UT), Dr. Paul van der Valk (MST), Dr. Wendy van Beurden (MST), Drs. Hans Timmer (ZGT), Prof. dr. ir. Séverine Le Gac (UT), Dr. Marjolein Brusse-Keizer (MST), Drs. Rob Klont (MST and LabMicTA)

APPLYING TECHNOLOGY IN HEALTHCARE VOUCHERS

STEERING INTO THE FLOW - GAMIFIED SPIROMETRY FOR TELEMONITORING OF CHILDREN WITH ASTHMA

Asthma is the most common chronic disease for Dutch children (280k). These children are at risk of a low quality of life. Modern technology allows real-time monitoring of lung function at home, enabling caregivers and healthcare providers to timely anticipate to worsening of asthma control. Previous research however revealed that the compliance and reliability of home-measured lung function measurements are suboptimal. This project aims to improve this with the aid of instructive gamified feedback through;

1. behavioural steering using various responsive blowing metaphors,
2. different forms of feedback based on rule-based artificial intelligence.

Dr.ir. Robby van Delden (UT), Mattienne van der Kamp (MST), Dr.ir. Alejandro Moreno (Saxion), Dr. Floor Sieverink (UT), Dr. Boony Thio (MST), Dr. Randy Klaassen (UT), Dr. M. Gorissen (DZ), René Stam (Game Lab Oost)

GO UP IN SMOKE!

Tobacco dependency is a complex, chronic disease. Successful treatment is possible, but more difficult for vulnerable groups, such as patients with psychiatric illness, low literacy or intellectual disabilities. They benefit from ‘doing’ rather than talking. Virtual reality (VR) offers an attractive opportunity to treat tobacco dependency in a save and personalized environment. We induce craving by introducing the participants to virtual risk situations, and concurrently measure their physiological reactions. Participants learns to reduce craving, by applying self-control techniques, and learn which, factors induce and reduce their cravings. Treatment of tobacco dependency thus becomes much more practical and fun! 

Dr. Joanneke van der Nagel (UT/Tactus), Drs. Michiel Eijsvogel (MST), Dr. Randy Klaassen (UT), Drs. Sicco Smit (ZGT), Dr.ir. Dennis Reidsma (UT), Dr. Paul van der Valk (MST), Drs. M. Bevers (Tactus), Drs. R. Ploeger (ZGT), Jan Kolkmeier (UT), Drs. Robert van de Graaf (KNMG)

IS THE CHEMO WORKING? – ARTIFICIAL INTELLIGENCE FOR RESPONSE EVALUATION OF ANTI-TUMOR TREATMENT

In breast, colon and lung cancer, the effect of anti-tumor treatment is evaluated based on changes of the tumor as visualized in CT scans or MRIs. With international validated assessment methods (RECIST1.1, iRECIST), the expansion/shrinkage of tumors during the course of the treatment is determined. The inter-observer variability of these (manual) assessments is large. The assessments themselves can be inaccurate tending to overtreatment. For the radiologists, these assessments are time-consuming. The goal of this project is to improve the accuracy and reproducibility of the evaluation of tumor treatment by exploiting automated pattern analysis and machine learning technology applied to CT-scans.

Dr. Alex Imholz (DZ), Dr.ir. Ferdi van der Heijden (UT), Dr. Rob van Dijk (DZ), Dr. Françoise Siepel (UT)

TUMOR CELL DETECTION, ISOLATION AND ANALYSIS FROM LYMPHNODES FOR PERSONALIZED THERAPY

The presence of micro-metastasis in lymph nodes has a large impact on the treatment of solid tumors. Within this proposal, the Puncher technology developed within the chair of MCBP of the University of Twente, will be applied for the detection of tumor cells in lymph nodes followed by the isolation of these cells for downstream DNA analysis.

By using this technology, the chance of detecting a tumor cell inside the lymph node increases as well as the presence of DNA mutations within these cells can be analyzed. This will help in selecting the most effective therapy, which will lead to a better treatment and better patient outcome. 

Dr. Barry Kolenaar (MST), Prof.dr. Leon Terstappen (UT), Dr. Kiki Andree (UT)

GIANT CELL ARTERITIS IN SIGHT; A COMPARISON OF ULTRASOUND, PET-CT AND MRI

Giant cell arteritis is a vasculitis occurring above the age of 50 potentially leading to disastrous complications such as blindness and CVAs. Temporal artery biopsy is the gold standard for diagnostics. However, this is insensitive, invasive, costly and leads to delays. Ultrasound, FDG-PET, MRI/MRA offer an alternative. With this pilot study we will compare these imaging techniques for the first time to improve diagnostics of GCA. Furthermore, with this collaboration we intend to improve imaging techniques. Due to little knowledge in this area, this study is warranted internationally to eventually reduce practice variation, improve health outcomes and reduce healthcare costs.

Dr. Celina Alves (ZGT), Dennis Boumans (ZGT), Dr. Edgar Colin (ZGT), Dr. Erik Groot Jebbink (UT), Dr. Erik Koffijberg (UT), Prof.dr. Riemer Slart (UT), Dr. Marloes Vermeer (ZGT), dr. Onno Vijlbrief (ZGT), Nils Wagenaar MD (ZGT), Jordy van Zandwijk, MSc (UT)

WEARABLE BREATHING TRAINER: MEASURING AND COACHING FOR CHILDREN WITH DYSFUNCTIONAL BREATHING PATTERNS

Respiratory disorders such as asthma and dysfunctional breathing (DB) are common in childhood. Exercise challenge tests can assess both the asthmatic and DB component of symptoms. However, exercise tests are hospital-based and expensive. Analysis of respiratory symptoms and assessment of efficacy of therapy in the home environment could provide the pediatrician and child an objective tool to acquire relevant data. This project will investigate how a ‘Wearable Breathing Trainer’ (WBT) can signal respiratory parameters, detect and analyze respiratory disorders and provide real-time feedback to the child. The WBT uses sensors and robotic textile and will be designed to support self-management.

Dr. ir. Geke Ludden (UT), Dr. Boony Thio (MST), Pascal Keijzer MSc (MST), Dr. Eliza Bottenberg (Saxion), Dr. Angelika Mader (UT), Dr. Jean Driessen (ZGT), Hellen van Rees MA (textile and fashion designer, Hellen van Rees)

TECHNOLOGICAL PIONEERING IN HEALTHCARE VOUCHERS

MAGNETICALLY-ACTUATED DEPLOYABLE-STENT CATHETER FOR PERCUTANEOUS CORONARY INTERVENTIONS

Coronary heart disease is the leading cause of death in the world, and Percutaneous Coronary Interventions are commonly employed to treat this condition. The aim of this proposal is to improve the success rate of this procedure through the development of a novel catheter system capable of stent implantation using magnetic actuation. The proposed method will improve control over catheter steering, thereby reducing damage to blood vessels, and will decrease radiation exposure compared to prevalent fluoroscopic guiding techniques. Improved surgical efficiency and reduced hospitalization times will mean better utilization of medical resources and personnel, and superior quality of life for patients.

Dr. Venkatasubramanian Kalpathy Venkiteswaran (UT), Prof.dr. Jan Grandjean (MST), Prof.dr. Sarthak Misra (UT)

DOES BLOOD FLOW INFLUENCE THE OUTCOME OF ENDOVASCULAR ABDOMINAL ANEURYSM REPAIR?

Enlargement of the large abdominal artery is treated by reinforcing it from the inside by means of a stent, thereby preventing further dilation. This approach shortens hospital stay and dramatically accelerates the return to normal daily activities. A potential drawback consists in occlusion of the stent, possibly resulting from blood flow disturbances induced by the arterial and stent geometry. This project will investigate the relation between stent shape, blood flow disturbances and stent occlusion using the latest, ultrasound based, blood flow visualization techniques and actual patient clinical data. The results will improve stent design and patient outcome.

Dr. Erik Groot Jebbink (UT), Jaimy Simmering (MST), Dr. Guillaume Lajoinie (UT), Prof.dr. R. Geelkerken (MST)

PNEUARMM: PNEUMATICALLY ACTUATED ROBOT FOR MINIMALLY INVASIVE MRI GUIDED INTERVENTIONS

Lung cancer is the most fatal neoplasm among adult population. Proper diagnostic and therapeutic technologies with lower costs, less side effects and higher accuracy, are key to a successful treatment. MRI/CT-compatible surgical-assistive robots are one of promising advancements in this regard. However the application of the technology in thorax interventions has been limited. PneuARMM is an initiative of UT-SRL, MST and PneuRobotics company to develop the platform required for safe, affordable, MRI-compatible, robotically assisted minimally invasive pulmonary interventions. The knowledge from PneuAct, MIRIAM and RICIBION projects will be directly utilized to develop a patient-mounted, pneumatically-actuated, parametrically-designed, multi-modality compatible and disposable surgical apparatus.

Prof. Sarthak Misra (UT), Dr. Dick Gerrits (MST), Foad Sojoodi Farimani (UT)

M4FAT; FAT METABOLISM MONITOR AND MOTION MOTIVATOR

Worldwide the prevalence of obesity has increased dramatically. Currently more people die of obesity than malnutrition. In the Netherlands half of the adult population has overweight and 13,9% suffers from obesity. Frequently obesity starts in childhood: 90% of the obese kids grow to be obese adults. Sustained reactivation is key for the treatment of childhood obesity but frustrated by relapse. The relation between exercise and fat metabolism is inter- en intra-individually highly variable. There is a need for a sensoring tool that can provide real-time feedback on the balance between metabolism and exercise intensity, sustaining physical reactivation.

Dr. Frits Oosterveld (Saxion), Dr. Boony Thio (MST), Maureen Gortemaker (Kinderfysioteam Enschede), Dr. Cas Damen (Saxion), Ir. Karin van Beurden (Saxion), Dr. Remko Soer (Saxion), Ir. Albert van Gool (MetaSenze)

REGULAR VOUCHERS

BREAST MILK AND HUMAN MILK FORTIFIERS: WHAT DO WE FEED OUR BABIES?

The protective properties of breast milk are invaluable for premature infants. However, breast milk alone does not always guarantee optimal mental and physical development for these vulnerable infants. Therefore, enrichment by Human Milk Fortifiers (HMF) is inevitable. The problem is that the current HMF composition cannot be fine-tuned to the patient’s individual nutritional needs, because of the unknown breast milk consumption by the infant. Our solution is to use Multi-angle Light Scattering to answer the question: what is in the breast milk consumed by these infants? This information can potentially help to formulate an individualized approach to HMF dosage.

Dr.ir. Nienke Bosschaart (UT), Drs. Ageeth Kaspers (MST), Lya den Haan (MST)

VALUE BASED HEALTH CARE IN BREAST CANCER FOLLOW-UP

Follow-up in patients who are treated for breast cancer aims to detect recurrent disease in an early stage, but varies in daily practice and is not based on the personalized risk of recurrence. With help of procesmining techniques daily practice of follow-up can be mapped from the combined databases of SANTEON, the Netherlands Cancer Registry and Performation. The effect of re-structuring of follow-up based on individual risks of recurrence (estimated using the INFLUENCE nomogram) and the wish of the patient on organization of care, the burden for the patient and the costs will be simulated in models.

Prof.dr. Sabine Siesling (UT), Dr. Erik Koffijberg (UT), Dr. Karin Groothuis-Oudshoorn (UT), Dr. Sandra Oude Wesselink (MST), Dr. Esther van 't Riet (DZ), Ir. Steven Lugard (Performation), Drs. Kay Schreuder (IKNL/UT), Dr. A. Dassen (MST), Dr. Jeroen Veldman (ZGT). 

MICRORNA PROFILES IN BLOOD AND URINE IN LUNG CANCER: A PILOT STUDY

Early stage detection of cancer is crucial and determining for the chances of curing a patient and the costs of treatment. The aim of this study is to investigate how the expression profile of the microRNAs (a class of biomarkers) in urine and blood of lung cancer patients is different from that of healthy persons with statistical learning techniques. This will tell us if the urinary microRNA profile can be used to detect lung cancer in a non-invasive manner and will answer the question whether or not urine-based microRNA detection methods can form the basis of novel health-monitoring tests.

Dr. Karin Groothuis-Oudshoorn (UT), Dr. E. Citgez (MST), Dr. J.H. Schouwink (MST), Dr. J. de Rooij (JR&D Services) 

EARLY RECOGNITION OF VITAL INSTABILITY AFTER ESOPHAGEAL ONCOLOGIC SURGERY

Surgical treatment of esophageal cancer is known to have a high risk of severe complications where early intervention is critical to prevent unnecessary damage. Unfortunately, deterioration in patients may remain unnoticed within the hospital ward despite daily nurse controls. To detect instability in an early phase, we are developing an unobtrusive system to continuously monitor vital signs. For this aim, we make use of wireless sensors, and are working on algorithms to identify relevant trends and abnormalities in the continuous data. This technology supports care professionals in early recognition of deterioration, and enables timely treatment of patients.

Dr. Ewout Kouwenhoven (ZGT), Mathilde Hermans MSc. (UT) 

SAXION VOUCHERS 

MEASUREMENT OF MEDICINE MIXTURES IN IV SYSTEMS

During simultaneous drug delivery to neonates via IV-systems undesired and harmful dosing errors can occur, by a combination of low flow levels and relatively high medicine concentrations. In this proposal the application of a multi-parameter chip is investigated for locally determining the composition of the IV fluid just before it is introduced into the patient. The chip measures the composition by analysis of the physical parameters of the IV fluid. By comparing these properties with the expected values based on the setpoint of the pumps, drug administration can be carried out with higher confidence, yielding a better clinical result.

Prof.dr.ir. Joost Lötters (UT), Dr.ir. Cas Damen (Saxion), Dr.ir. Bärbel van den Berg (MST) 

ELECTRO-MECHANICAL RESYNCHRONISATION THERAPY WITH A SMART MATERIAL FOR PATIENTS WITH HEART FAILURE

In order to support the failing heart, in 2017 we demonstrated a proof of principle by sending an electrical signal through a smart material to improve the hearts pump function. With this research we aim at a proof-of concept of electro-mechanical resynchronization therapy and bring this therapy closer to patientcare. We apply shape-memory alloys around a failing heart (model) and use experts from UT (materials science), MST (cardio-thoracic surgery), ZGT (cardiology, heart failure) and Saxion (ambient intelligence, smart materials). Shape-memory alloys are tested in different designs and in increasing complex heart models with a goal to improve contractility of the heart.

Dr. Salah A.M. Said (ZGT), Dr.ir. Jos Paulusse (UT), Prof.dr. Jan Grandjean (MST), Drs. Frank Halfwerk (MST/UT), Dr.ir. Wouter Teeuw (Saxion), Ir. Ger Brinks (Saxion) 

PERSONALIZED MOBILE ALCOHOL AVOIDANCE TRAINING TO REDUCE ALCOHOL CONSUMPTION IN PROBLEM DRINKING GASTROENTEROLOGY PATIENTS

Many gastroenterology patients drink excessively, but since most patients experience a high threshold to regular addiction care, they often do not get adequate support for their problematic drinking. Furthermore, regular care is not 24/7 available, which makes it often unavailable during the difficult craving moments. Therefore, gastroenterologists are in need for an easily accessible, low-effort, 24/7 intervention that they can provide to their patients. A personalized version of the mobile Cognitive Bias Modification Alcohol Avoidance Training could fulfill these needs. Within this project, the personalized version of the app, including gamification elements, will be developed and evaluated.

Dr. Marloes Postel (UT), Dr. Maureen Guichelaar (MST), Drs. Melissa Laurens (Saxion), Dr. Somaya Ben Allouch (Saxion), Dr. Randy Klaassen (UT), Dr. Marjolein Brusse-Keizer (MST), Dr. Marcel Pieterse (UT) 

ASSESSMENT OF MOTOR DEVELOPMENT IN THE FUN POPULATION

In the Netherlands, roughly 8% of all newborns are born prematurely. Although survival of these prematurely born children has increased dramatically over the last decades, morbidity remains high. Pulmonary, ocular and development disorders are frequent in this population. In standard follow-up motor development is regularly evaluated with the Movement Assessment Battery for Children-2 (ABC-2), a validated, but time consuming and insensitive method. An automated and sensitive evaluation of motor development in prematurely born children is new and will prove to be a technical challenge, which, if successful, can revolutionize therapeutic modalities in this vulnerable population.

Dr. Jean Driessen (ZGT), Ageeth Kaspers (MST), Jaap Buurke (RRD/UT), Rianne Huis in 't Veld (ZGT), Anne Schoot (MST), Bart Koopman (UT), Wouter Teeuw (Saxion) 

MENZIS VOUCHERS 

DEEPSLEEP: DEEP LEARNING BASED AUTOMATED SLEEP STAGING SYSTEM

Sleep disorders such as insomnias, sleep apnea and sleep movement disorders affect nearly 50-70 million adults every year. Overnight polysomnography (PSG) is the gold standard tool for diagnosing sleep disorders. Currently, sleep staging is done through visual analysis of PSG recordings by experienced sleep technicians, which is a tedious task and such manual annotation is subject to both intra and inter-rater variability. The aim of this study is to develop a robust, reliable and automated sleep staging tool DEEPSLEEP using deep learning techniques which can assist sleep technicians for more reliable, cost-effective and efficient diagnosis and monitoring of sleep disorders.

Dr. Sunil Belur Nagaraj (UT), Dr. Ainara Garde (UT), Prof.dr.ir. Michel van Putten (MST/UT), Prof.dr. Hermie Hermens (RRD/UT), Mirjam Stappenbelt (MST), Dr. Iris Knottnerus (MST) 

A HEALTHY MIND IN A HEALTHY BODY

Unhealthy eating and activity behaviors result in insufficient weight loss following bariatric surgery. In current treatment, the importance of individual variation in behavioral components (such as eating, activity, emotion, cognition and context) and how these components might influence each other, are barely taken into consideration. This project focuses on development of an ambulant system that monitors behavioral components unobtrusively in daily life of patients, and the integration of the data into individual behavioral patterns. The results will be used for a personalized intervention that promotes healthy behavior in daily life, tailored to the specific needs, preferences and conditions of patients.

Dr. M.J. van Det (ZGT), Dr. M. Poel (UT), Mevr. J.G. Timmerman (ZGT), Dr. I.F. Faneyte (ZGT), Dr. Oresti Banos (UT),  

DEVENTER ZIEKENHUIS VOUCHER

IMPROVING BREAST CANCER TREATMENT: MAPPING OF HISTOLOGICAL FINDINGS IN DISSECTED BREAST SPECIMEN TO 3D LOCATIONS IN THE PATIENT

Lumpectomy is very common in patients with breast cancer. After dissecting the lump, specimen changes ex-vivo, which results in uncertainty in the resection margin. As a result, follow-up treatment might be unnecessarily intensified (reoperation or radiation therapy). In this feasibility study, it will be investigated whether (positive) resection margins can be determined more accurately by visualizing/ reconstructing the specimen of a lumpectomy to represent the in-vivo situation. To do so, a 3D virtual volume will be created based on 2D histological features. This 3D virtual volume will be compared to pre-pathological 3D images.

Dr. Mirre de Noo (DZ), Dr.ir. Ferdinand van der Heijden (UT), Dr. Esther van 't Riet (DZ), Dr. Françoise J. Siepel (UT) 

RAPID POINT-OF-CARE SEPSIS TEST

Fast and reliable diagnosis of sepsis at the hospital bedside would improve patient treatment and potentially save many lives. Current tests are either slow as they require blood culture, or unreliable as they are based on only one particular biomarker. We will extend our existing platform for point-of-care blood analysis to allow for the quantification of many soluble and cell surface biomarkers in parallel. By combining several known sepsis biomarkers in one test, providing results within 30 min with minimal sample preparation, we expect a significantly increased sensitivity and specificity in a format compatible with bedside testing. 

Dr. Markus Beck (UT), dr. Jennita Slomp (MST- Medlon), dr. Bert Beishuizen (MST), dr. Alex Cornet (MST), dr. Dorothee Wasserberg (UT), Joost van Dalum (UT)

BIOMARKERS IN MESENTERIC ISCHEMIA

Mesenteric ischemia has a high mortality and morbidity, because diagnosis is often (too) late. The main shortcoming is early detection. Biomarkers have emerged as a diagnosticum for a number of years. Due to the development of a lab-on-a-Chip, we aim to provide patients and clinicians with a minimally invasive, simple and relatively inexpensive blood test. Making early detection and rapid treatment possible, which will lead to lower mortality, morbidity and costs. With this voucher, we want to investigate what techniques we can use to build the chip.

Drs. Juliette Blauw (MST, LUMC), dr ir. Loes Segerink (UT), prof. dr. Bob Geelkerken (MST, UT), prof. dr. Jeroen Kolkman (MST, RUG), dr. Marjolein Brusse-Keizer (MST)

RAPID MICROSENSOR TO DIAGNOSE BACTERIAL INFECTION IN COPD EXACERBATIONS

A correct determination of when to use antibiotics is urgently needed worldwide for the reduction of costs, side effects and risks such as resistant bacteria. A novel acoustic and colorimetric sensor to measure dynamic viscoelastic and color properties of small quantities of sputum could help in a fast and univocal way in the diagnosis of exacerbation of bacterial origin. Sputum properties vary very fast; hence cheap and reliable regular checks are needed. In this project we are initiating a new collaboration between the UT, MST and ZGT towards developing a hand-held device for diagnosis at the hospitals or at home.

Dr. David Fernandez Rivas (UT), dr. ir. Frans de Jongh (MST), dr. Paul van der Valk (MST), Timon Fabius (MST), Hans Timmer (ZGT), dr. Marjolein Brusse Keizer (MST), prof. dr. Michel Versluis (UT)

DEVELOPMENT OF AN OBSTRUCTIVE SLEEP APNEA (OSA) DIAGNOSTIC TOOL USING A NASAL SENSOR THAT ALLOWS MEASURING PULSE OXIMETRY AND AIRFLOW SIGNALS

Prompt diagnosis and treatment of obstructive sleep apnea (OSA), a form of sleep-disordered breathing characterized by breathing cessations, is vital as untreated OSA is linked to hypertension, arrhythmias, heart failure, and stroke. Polysomnography (PSG), the gold standard diagnostic tool, is resource intensive and not widely available, resulting in long waiting lists and delays in diagnosing people in need. Thus, the aim of this study is to develop a portable, non-invasive, smartphone-based technology, not only to screen but also to diagnose OSA at home using an innovative nasal sensor that allows measuring both pulse oximetry and airflow simultaneously

Dr. Ainara Garde (UT), drs. Michiel Eijsvogel (MST), dr. ir. Frans de Jongh  (MST), prof. dr. ir. Hermie Hermens (UT), Maarten Ruinemans (ZGT)

MRIPRO: LOWFIELD MRI AS A DIAGNOSTIC TOOL TO SIMULTANEOUSLY DIFFERENTIATE BETWEEN UNDERLYING CAUSES OF PROBLEMATIC KNEE PROSTHETICS

No diagnostic tools are currently available that are capable of simultaneously differentiate between various causes of (persistent) complaints of pain and / or instability in patients after primary total knee replacement. In order to be able to determine an effective treatment strategy, patients undergo a variety of (radiological) examinations and / or consultations. Due to its metal artifact reducing properties low field MRI provides the ability to simultaneously differentiate between various causes for problematic knee replacement so that targeted treatment strategies can follow faster en cheaper. This study is aimed at establishing and validating a scan protocol using low field MRI to make simultaneous differential diagnosis around problematic knee replacement possible.

Dr. Rianne Huis in ´t Veld (ZGT), dr. Anne Vochteloo (ZGT), dr. ir. Bennie ten Haken (UT), prof. dr. ir. Nico Verdonschot (UT)

DELICATE: DIABETES AND LIFESTYLE COACHING PROJECT TWENTE

Insufficient physical activity, often starting at a young age, causes health problems including diabetes mellitus type 2. Interventions aimed at lifestyle changes, are necessary but unsuccessful so far. Here, we develop an application that will measure parameters, relevant for glucose regulation, but not regularly available (physical activity, sleep, diet, continuous glucose monitoring). The challenges are to phenotype patients based on the collected data (current project), and ultimately to develop a portable automated personalized coaching system aimed at healthy behavior and better glucose regulation, that takes into account all relevant individual factors including insulin-sensitivity (follow-up project).

Dr. Goos Laverman (ZGT), prof. dr. Miriam Vollenbroek-Hutten (ZGT, UT), drs. Christina Gant (ZGT), dr. ir. Bert-Jan van Beijnum (UT), prof. dr. ir. Hermie Hermens (UT), 

EARLY DETECTION OF FOOT COMPLICATIONS IN DIABETES USING INFRARED IMAGING TECHNICS FOR SMARTPHONES

Two percent of the people with diabetes develop foot ulcers. Foot ulcers are the most important reason for amputation in people with diabetes. Early detection and treatments of wounds are effective in prevention of amputation. Currently it is known that heightened skin temperature in the foot is an indication for the development of a wound. The aim of this project is to realize a camera based home monitoring system that gives the patient and professionals detailed insight in the development of foot complications so that measures can be taken timely and a wound can be prevented.

Dr. Sjef van Baal (ZGT), dr. ir. Ferdi van der Heijden (UT), dr. Jaap van Netten (Queensland University of Technology), prof. dr. Miriam Vollenbroek-Hutten (UT, ZGT)

SELF-MANAGEMENT AND TELEMEDICINE IN PATIENTS WITH COPD AND CHRONIC HEART FAILURE

We want to develop a home-based motivational self-management programme for patients with COPD and heart failure. Using telemedicine, self-management will be patient-tailored and more accessible by offering care at distance. Elements include action plans for self-treatment of exacerbations, an avatar for better communication and personal feedback, sensorised inhalers for improved medication adherence, and a test to determine the cause of breathlessness symptoms. This will lead to better decision making and an earlier start of proper treatment in the home-setting. In particular, this is important for frail older patients with COPD and heart failure, with potentially other diseases as well.

Anke Lenferink (MST, UT, Flinders University), dr. Gerard Linssen (ZGT), prof. dr. ir. Hermie Hermens (UT), dr. Paul van der Valk (MST), dr. ir. Monique Tabak (RRD), Martijn Grinovero (Amiko), prof. dr. Miriam Vollenbroek-Hutten (UT, ZGT), prof. dr. Job van der Palen (MST, UT), dr. Tanja Effing (Repatriation General Hospital, Flinders University)

MENZIS PIHC VOUCHER

“UP AND GO” AFTER A HIP FRACTURE

Functional recovery and going back to the former living situation after a hipfracture is currently suboptimal. “Up and go” after a hipfracture aims to develop a technology supported service that monitors progress of the older adults during rehabilitation up to 6 months after surgery. This information is accessible for the involved care professionals, which enables that the right action is taken by the right professional at the right time. In addition, personalized motivated feedback and advises can also be provided to the older person himself so he/she is able to optimize his/her own rehabilitation process also.

Dr. Han Hegeman  (ZGT), Ellis Folbert (ZGT), prof. dr. Miriam Vollenbroek-Hutten (UT, ZGT), prof. dr. ir. Hermie Hermens (UT), Fred Schrander MBA (Trivium Meulenbelt Zorg), dr. Anno Wester (Carint Reggeland), drs. Monique van Hattem (Thuiszorg Noord West Twente)

REGULAR PIHC VOUCHERS

POINT-OF-CARE TEST TO GUIDE ANTIBODY THERAPY: MAB-ON-A-CHIP. (UT - MST - ZGT)

Monoclonal antibodies (mAbs) are widely used in the treatment of inflammatory and malignant diseases. Although mAb therapy has shown clinical benefit in many patients, initial response rates vary between 50- 90% and in a majority of patients an initial response is lost over time resulting in disease progression. Lack of response to mAbs has been associated with inadequate mAb serum concentrations. Therapeutic drug monitoring (TDM) of mAbs has the potential to guide to more effective dosing in individual patients. The goal of this project is to develop a point-of-care test platform for measuring mAb concentrations: mAb-on-a- Chip.

Dr. Thijs Oude Munnink (MST), Dr. Kris Movig (MST), Dr. Ron Gill (UT), Dr Ton Vrij (ZGT), Dr.ir. Loes Segerink (UT), Dr. Maurice Russel (MST)

A NEW FIELD FOR PHOTOACOUSTIC IMAGING: FROM VALIDATION IN HEALTHY FEET TO CRITICAL LIMB ISCHEMIA DETECTION IN PEOPLE WITH DIABETES

People with diabetes are prone to develop chronic foot ulcers that may result in amputation of the leg, having a major impact on patients’ quality of life. Perfusion is crucial in healing and level of amputation determination. Accurate detection of perfusion is the greatest challenge nowadays in diabetic foot disease, with available techniques failing to reach adequate diagnostic and prognostic properties. Photoacoustic imaging (PAI) is a credible candidate for this application. Purpose of this study is to validate this technique in healthy feet, monitoring foot ulcers, and assess whether PAI can be used in the operating room under sterile conditions.

Prof. dr. R.H.J.A. Slart (UT), Prof. dr. W. Steenbergen (UT), Dr. J.J. vn Netten (ZGT), Dr. J. van Baal (ZGT), Dr. R Meerwaldt (MST), Dr. R.H. Geelkerken (MST)

IMPROVES DIAGNOSTICS ON POST SURGICAL PAIN - ALTERED TREATMENT APPROACH? PREVENTION OF CHRONIC PAIN? REDUCTION OF HIGH COSTS? (UT - MST - ZGT)

This project focusses on the role of new technology for pain diagnostics in the prevention and treatment of chronic pain after total knee replacements (TKA). Increased pain sensitivity plays a key role in chronic pain development. Early detection and targeted treatment could prevent chronic pain and save many costs. At UT-BSS, unique technology has been developed for point-of-care monitoring of pain sensitivity. At ZGT-OCON and MST/ZGT-Nocepta, this technology could support decisions on TKA and improved pain management. In a pilot study, the merits of pain sensitivity monitoring are assessed. UT-HTSR will study the relation between chronic pain and healthcare costs.

Dr. ir. J.P. Buitenweg (UT), Dr. C.J.M. Doggen (UT), Dr. R. Huis in 't Velt (ZGT, OCON), Dr. A.Janssen (ZGT), Dr. M Hanje (MST, Nocepta).

ENHANCED REALITY PANORAMATIC USER INTERFACE FOR NAVIGATION AND DOCUMENTATION OF ENDOSCOPIC GUIDED SURGERIES (PANOSURG) (UT - ZGT)

In breast cancer screening, different imaging modalities are used such as mammography, ultrasound and sometimes also MRI because of the high sensitivity for lesions. A lesion may need to be biopsied to determine its malignancy and decide on the right treatment. The lesion then needs to be punctured with a biopsy needle under MRI guidance. The current manual procedure is cumbersome and inaccurate, sometimes the lesion is missed resulting in disadvantages. A robot could perform the procedure more precisely and efficient. A complicating factor in developing such a robot is the strong magnetic field in and around the MRI scanner which may not be distorted, which severily restricts the use of electric motors and metallic materials. Thus it is decided to develop a fully plastic robot, driven by custom pneumatic stepper motors which are controlled by valves outside the MRI room.

Prof. dr. ir. Stefano Stramigioli (UT), Dr. Erik Cornel (ZGT), Ir. Foad Sojoodi Farimani (UT)

ADAPTIVE REBREATHING FOR CENTRAL SLEEP APNEA TREATMENT (UT - MST - ZGT)

The aim of this research is to develop a device which enables regulation of carbon dioxide levels in the blood during sleep to prevent central sleep apneas. This device should consist of a mask in which exhaled air can be stored and a valve which can regulate the amount of air that is rebreathed. Furthermore, a sensor which can non-invasively measure the amount of carbon dioxide in both the exhaled air and in the blood is needed. Validation studies will be performed by UT master students under combined supervision of technical and medical experts at the MST and ZGT.

Timon Fabius (MST), Frans de Jong (MST/UT), Michiel Wagenaar (MST), Maarten Ruinemans (ZGT), Hans Tragter (UT), Jan Hendrik Crockewit (UT), Niel Tas (UT), Han Gardeniers (UT).

BIOMEDICAL SENSING AND SMART COACHING IN A MOBILE GAMING ENVIRONMENT FOR IMPROVING ASTHMA CONTROL IN CHILDREN: AIRPLAY (UT - MST - ZGT)

Self-management is the key in successful treatment of childhood asthma. Current healthcare fails to support in acquiring self-management skills, expressed by a critically low treatment adherence and treatment failure. We need to support beyond the medical environment into daily life. Therefore, we aim to develop an innovative proof-of-concept: AIRplay. AIRplay incorporates sensing and smart coaching strategies in a mobile gaming environment, to improve medication adherence and physical (re-)conditioning, and learn children self-manage their asthma in a fun manner.

Dr. ir. Monique Tabak (UT), Prof. dr. Miriam Vollenbroek (UT), Dr. Marjolein Brusse-Keizer (MST), Dr. Boony Thio (MST), Dr. Ir. Rieks op den Akker (UT), Drs. Ellen van der Gaag (ZGT)

PRESSURE CONTROLLED HIGH-FLOW THERAPY FOR AIRWAY INFECTIONS (UT - MST)

Severe airway infections in infants are increasingly treated by non-invasive high-flow nasal cannula (HFNC) therapy which provides a flow-rate controlled increase of airway pressure and prevents respiratory insufficiency. However, there is a large uncertainty in the generated pressure level which has received world-wide attention over the last decade. To remove this uncertainty we investigate the feasibility of switching from flow rate controlled therapy to pressure controlled therapy. Both in-vivo and in-vitro experiments have been conducted, preliminary results are promising.

Dr. R. Hagmeijer (UT), dr. B.J. Thio (MST), prof. dr. ir. C.H. Venner (UT), drs J.F. Goorhuis (MST)

MULTIMODAL BRAIN MONITORING IN TRAUMATIC BRAIN INJURY (UT - MST)

Severe traumatic brain injury is one of the leading causes of death and invalidity among young adults. Due to ventilation and sedation, clinical evaluation is often limited, while there is a risk for secondary brain injury in the first days after admission. There is a strong need for new methods to detect this secondary deterioration in an early stage. With the use of multimodal brain monitoring, in which EEG, transcranial doppler and intracerebral pressure measurements are combined with CT perfusion scans and clinical scores, more insight will be obtained in the pathophysiological processes of traumatic brain injury. Thereby, treatment might be improved for future patients.

Dr. M.C. Tjepkema-Cloostermans (MST), Prof. dr. ir. M.J.A.M. van Putten (MST/UT), Dr. A. Beishuizen (MST), Drs. H. Hom (MST), Dr. J. Hofmeijer (UT/Rijnstate)

MENZIS PIHC VOUCHERS

E-HEALTH IN EARLY CARDIAC REHABILITATION AFTER CARDIAC SURGERY

E-health might be a solution to respond to the demand of patients to have more influence on their rehabilitation and start earlier in the postoperative phase after open heart surgery. Aim of the project is to develop and evaluate a personalized intelligent home-based online exercise program, to be used by patients after discharge from the hospital. This application supports the process of therapeutic examination, clinical reasoning and treatment, and offers patients the possibility to participate in a tailored rehabilitation programm at home. By starting the rehabilitation in an earlier phase, we expect patients to start the regular rehabilitation in better physical condition and to gain better health outcomes. Furthermore, an online exercise program increases the possibilities of self management and might increase efficiency of future cardiac rehabilitation.

M. van Dijk (MST), Prof. dr. G.J. Grandjean (MST), Dr. M. Veehof (MST), Prof. dr. M. Vollenbroek-Hutten (UT/RRD), Dr. M. Tabak (UT/RRD)

DIAGNOSAS AS A SCREENINGTOOL FOR OBSTRUCTIVE SLEEP APNEA SYNDROM IN THE GENERAL PRACTICE.

In patients with obstructive sleep apnea syndrome (OSAS), breathing stops occur repeatedly during sleep. Untreated OSAS leads to severe health problems and impaired overall functioning during the day. Although OSAS is well treatable, an estimated 250.000 Dutch inhabitants with OSAS are still undiagnosed. In addition, approximately 35% of the patients referred to the hospital for a specialized sleep study do not have OSAS. An important reason for this discrepancy is the lack of a reliable screening test for the general practitioner. In the present study, the diagnostic parameters of ‘DiagnOSAS’ (combination of an online questionnaire combined with overnight pulxeoximetry) will be examined as a novel screening test for OSAS in the general practice.

Drs. M.M.M. Eijsvogel (MST), Dr. E. Koffijberg (UT), Prof. dr. J. van der Palen (UT), Mevr. J.H.M. Mulder (Saxion), Drs. P.H.J.M. van Mechelen (Apneuvereniging), Mevr. L. van Steinvoren-Stamsnijder (Holland Innovative), Dr. R.G. Pleijhuis (MST), Dhr. J.R. Benistant, BSc (student UT), Drs. O. Hertgers (TIM Solutions), Drs. T. Fabius (MST)

REGULAR PIHC VOUCHERS

SMART GLASSES FOR PARKINSON PATIENTS. (UT – MST – ZGT)

The quality of life of Parkinson’s patients is dramatically reduced due to gait deficits, balance problems, and increased risk of falling. We want to develop and test the application of “smart glasses” technology in Parkinson’s patients to provide cues and feedback on gait, performance, balance and posture during daily activities, thereby increasing their independence and confidence. This smart glasses project will be used to build a network of local stakeholders (researchers, clinicians, patients, companies, government) that is necessary to develop new high-tech solutions for Parkinson patients.

Prof.dr. R. van Wezel (UT), Dr.ir. T. Heida (UT), Dr. Y. Zhao (UT), Dr. J. Nonnekes UT), Dr. M. Tjepkema-Cloostermans (MST), Dr. L. Dorresteijn (MST), Dr. J. van Vugt (MST), H.W. Nijmeijer (ZGT), A.A.A.C.M. Wertenbroek (ZGT)

BLOOD ANALYSIS WITHOUT PAIN IN NEONATES (UT – MST)

Invasive blood testing is required regularly (up to 3 times/day) in preterm and ill neonates, involving pain and other medical complications. This project aims for fast, non-invasive and painless measurements of the two most frequently determined blood values: bilirubin and hemoglobin. For this purpose, we will convert a recently developed technique (low-coherence spectroscopy, LCS) into a clinical system. LCS measures the optical absorption of bilirubin/hemoglobin in a probing volume inside skin that is highly controlled in both size and location. This enables bilirubin/hemoglobin measurements in blood vessels only, resulting in highly accurate determinations without any crosstalk from surrounding tissue.

Dr. ir. Nienke Bosschaart (UT), Prof. Dr. ir. Wiendelt Steenbergen (UT), M.D. Ageeth Kaspers (MST), Dr. ir. Bärbel van den Berg (MST)

COTININE MEASUREMENT USING LAB-ON-A-CHIP (UT – MST)

Smoking cessation is important for decreasing the risk of the development of smoking related diseases as well as for improvement of prognosis and treatment of these diseases. Quit rates of current smoking cessation programmes need to be biochemically validated due to the high number of deceivers. The gold standard for this validation is cotinine measurement. This measurement is expensive and is determined in batches which causes that the outcome is only available after several weeks or months. The objective of the proposed study is to develop a less expensive lab-on-a-chip cotinine measurement that can determine the cotinine level instantly. The diagnostic value of this tool will be evaluated in an already planned randomized controlled trial of two smoking cessation programmes.

Dr. Marjolein Brusse (MST), Dr. Marcel Pieterse (UT), Dr. Kris Movig (MST), Dr. Marloes Postel (UT/Tactus), Dr. ir. Loes Segerink (UT), Dr. Somaya Ben Allouch (Saxion), Dr. ir. Wouter Olthuis (UT), Dr. Paul van der Valk (MST)

STATE-OF-THE-ART IN PHOTOACOUSTIC CT TO VISUALIZE THE SYNOVIUM IN INFLAMMATORY JOINT DISEASE (UT – ZGT)

We propose a synergy between mathematics and imaging technology to facilitate high accuracy photoacoustic CT imaging of synovial joints in rheumatoid arthritis (RA) patients. Novel reconstruction techniques will be developed and validated on data from complex phantoms acquired using a new photoacoustic imager. The imager will also be used to measure on the inter-phalangeal joints of 10 RA patients. The refined algorithms will be applied to this data set. Our short-term goal is to visualize the inflamed synovial membrane in RA patients. Our long-term ambition is to make an impact in the diagnosis, and particularly, in the therapy monitoring of RA.

Srirang Manohar, PhD (UT), Christoph Brune, PhD (UT), Heins Moens, PhD (ZGT)

(IN)FERTILITY CHIP. SUCCESSFUL STERILIZATION FOR MEN OR NOT? (UT – MST – ZGT)

In order to review if a sterilization for a man is successful, a semen analysis is conducted three months after the procedure. The gold standard of semen analysis is optical judgment by laboratory employees. This is a variable, subjective, time-consuming and expensive method for which a man needs to bring a container with semen within 1 hour after production to a certified laboratory. With the Fertility chip the semen analysis can be automated. This will improve the test validity and reproducibility and semen can be analyzed at the nearest outpatient clinic. In cooperation with the departments of Urology and Clinical Chemistry of the Medisch Spectrum Twente (MST) and the Ziekenhuis Groep Twente (ZGT) a prototype analysis system will be tested to improve the semen analysis after sterilization and bring it closer to men.

Dr. M. Asselman (MST), Dr. C.J.A. Doelman (Medlon), Dr. ir. L.I. Segerink (UT), Drs. S. Stomps (ZGT), mr. A.G.J. de Moor (Characell BV i.o.)

TOTAL HIP ARTHROPLASTY: DEVELOPING AN AMBULANT DISLOCATION ALERT SYSTEM (HIP-DAS) (UT – ZGT)

One of the major complications after total hip arthroplasty is dislocation of the prosthesis. Today, to prevent an early dislocation, patients are instructed with movement restrictions by a physiotherapist in order to avoid critical joint angles. However, many patients feel anxious and insecure on how to properly comply with these movement restrictions during the execution of their daily activities without the continuous attendance of a physiotherapist. An ambulant dislocation alert system that automatically warns people when approaching or exceeding critical hip angles at any time and any place will provide self confidence to the patients during their activities of daily living and may reduce the risk of a dislocation. This project will result in a proof of concept prototype product.

MD A. Peters (OCON/ZGT), Phd. R. Huis in ´t Veld (OCON/ZGT), Prof. M. Vollenbroek/Hutten (UT), Prof. H. Hermens (UT), Ir. H. Luinge (Xsens Technologies BV)

THE MINIATURIZED ELECTRONIC NOSE (UT – MST)

An electronic nose ”smells” volatile organic compounds (VOC’S) which can be characteristic for the disease of a patient. Clinical applications are numerous. At the department of pulmonlogy they are used in research settings to detect and discriminate for instance asthma, COPD, sleep apnea and lung cancer. The main disadvantages of the electronic noses used nowadays are that they are relatively large, the sensors are expensive, measurements might be time consuming and results often can not be presented real-time. These problems can be solved when using an electronic nose based on so-called cantilever technology. The main goal of this project is to develop a clinical applicable miniaturized electronic nose at the University Twente which will be tested and validated at the lung function department of the MST-hospital Enschede.

Dr. Ir. Frans de Jongh (MST/UT/AMC), Dr P.L.P.D.M. van der Valk (MST), Drs M. Eijsvogel (MST), Dr. Ruud Steenwelle (UT), Prof. Dr. Ing. Guus Rijnders (UT), Prof. Dr.Ing. Dave Blank (UT)

MODEL-BASED PLANNING AND STEERING OF A BIOPSY NEEDLE IN THE BREAST TO OPTIMISE BIOPSY RESULTS. (UT – ZGT)

During the insertion of a needle in the breast, tissues will deform or move and the action of insertion could result in a wrong biopsy. The goal of the research is to look at available methodologies and possible innovations to anticipate on these deformations. By creating a lumped model of volumes based on MRI information, a longitudinal direction can be chosen ahead of time and possible longitudinal motion can be studied and analysed: vibration, constant velocity, etc. At the same time, in the checking MRI after needle insertion, data can be acquired to make the system learn from possible inaccuracies.

prof. dr. ir. Stefano Stramigioli (UT), dr. Jeroen Veltman (ZGT), dr. Jurgen Fütterer (UT), [Vincent Groenhuis (student UT)], Abe van der Werf (Machnet BV)

RUNNER-UP €25.000

DEVELOPMENT OF A MONITORING DEVICE FOR VULNERABLE NEONATES (UT – MST)

Premature neonates are vulnerable and require intensive monitoring of vital signs and repeated clinical assessments. This puts a burden on the child and cannot be done continuously. When a baby returns home, parents have to assess vital signs themselves, which may lead to uncertainty, misinterpretation, and putative dangerous situations. Motion Magnification could ameliorate these problems. A consortium, comprising of MST and three university departments, will address this clinical and societal problem by developing a near infrared monitoring device using Motion Magnification, and appropriate warning signals. Student projects will be started, with students from Technical Medicine, Biomedical Engineering, and Health Sciences.

Kees Slump (UT), Boony Thio (MST), Ferdinand van der Heijden (UT), Bernard Veldkamp (UT), Magda Boere-Boonekamp (UT), Maarten Ijzerman (UT), Job van der Palen (MST)