From operating room device to pocket-sized camera

Many clinical decisions depend on the question: Can this tissue still recover? Prof. Dr Bob Geelkerken (UT), vascular surgeon at MST and co-leader of the project, knows the dilemma like no other. "The surgical eye is simply not reliable enough," he says. "You can see if the tissue is dead or if it is healthy. But everything in between? It is easy to get it wrong."

That is why fluorescence imaging (FI) is now used as standard in the operating room at MST. A dye is administered via an IV drip. The dye flows through the body with the blood, and a special camera shows where it ends up. The dye appears quickly and clearly in well-perfused tissue, whereas in poorly perfused tissue, the dye appears slowly or not at all.

"We want to make the benefits of FI accessible to all areas of healthcare, not just the operating room," explains biomedical engineer Harry Vaassen. He is head of the fluorescence lab at MST and is also conducting PhD research at the Multi-Modality Medical Imaging (M3i) research group of the University of Twente. "The current systems are bulky, expensive, and designed for dozens of applications. Not workable for a nursing ward where you need a quick measurement."

VITAL-FI builds upon an algorithm that Harry developed for his master's thesis: the model converts fluorescence images into a number that predicts whether intestinal tissue will recover. “That was a real game changer,” says Bob. “For the first time, we had an objective measure to determine whether intestinal tissue was viable – and it proved to be reliable in practice.”

Bob gives an example of a situation where ‘Harry’s model’ was used: a patient whose colon appeared dead on the inside, but whose fluorescence values showed that the outer layer was still alive. “We left the intestine in place. And the patient went home with good bowel function. That was completely against the guidelines, but it was the right choice. That is the power of this technology.”

The goal now is to use the same principle outside the operating room, for example for diabetic foot problems or wounds resulting from (breast) reconstructions. “If you can detect a wound deteriorating earlier, you can also intervene earlier,” says Harry. "Currently, you rely on looking, feeling, and experience. But with the naked eye, you often notice too late that a wound is not healing properly."

The impact on patients is significant: when tissue deterioration is identified earlier, clinicians can intervene sooner. "If FI allows us to detect circulation problems hours before they become visible to the naked eye, the potential gains are enormous," says Harry. "In the case of breast reconstruction, that can mean the difference between a quick recovery or a painful process lasting months." Bob: "And it needs to become so simple that it can be applied everywhere in healthcare. Even in home care or nursing homes, so that a hospital visit or corrective surgery is needed less often."

A compact fluorescence camera might be the solution: affordable and easy to operate. "In the ideal scenario, a wound care nurse will simply carry a small camera that shows within a few seconds whether the circulation is sufficient for healing", says Bob.

VITAL-FI is a typical Twente project. MST brings the clinical experience and the fluorescence lab, ZGT the expertise in diabetic foot care and complex wounds, and the University of Twente provides the technology and testing facilities.

Bob says: “I would like to mention that Prof. dr. ir. Ruud Verdaasdonk from the UT is one of the initiators and the creative driving force behind the project. He made a significant contribution to the foundation of this project. Due to organizational changes, the technical development is now structured differently, but Ruud remains indirectly involved. We appreciate that enormously."

The PIHC voucher makes it possible to go from idea to prototype. "A non-academic hospital developing a medical device: that is unique. Without that support, you simply cannot do this," says Bob. "For us, PIHC is truly the catalyst for almost all our innovation lines. It starts small, but it can grow into something that becomes the global standard."

For the technical development, Harry and Bob are collaborating with Demcon, a high-tech developer originally from Enschede. Their engineers are now involved in the process. "They are the missing link capable of building a reliable, compact system," says Harry.

The first step is building a prototype, expected in the first quarter of 2026. This will be followed by tests in the UT lab under controlled conditions. "Thanks to the large number of patients in the region, we can quickly see if it works," says Harry. If the system works, clinical trials will follow, and then possibly broader implementation. To make the project a success, follow-up funding is needed for further development into a market-ready product. But the foundation is built and the ambition is clear: a camera so simple that every healthcare provider can work with it.

For Bob, VITAL-FI is more than a research project. "I am at the end of my surgical career. If this succeeds, it will be a wonderful culmination of the development that the founders of Technical Medicine started more than twenty years ago: truly bringing technology and medicine together. I think it is fantastic that our hospital’s technical medicine department holds an equal voice alongside the surgery department – that was unthinkable five years ago."

Harry: "In my master's project, I developed the algorithm that allows us to predict whether tissue is healing. We now use that 24/7 in the OR. If we can bring that same approach, together with a compact camera, to the outpatient clinic and home care, we will reach many more patients. That impact would be truly wonderful."

The Pioneers in Health Care (PIHC) Innovation Fund is a collaboration between the University of Twente (TechMed Centrum), Saxion University of Applied Sciences, and the hospitals MST, ZGT and Deventer Ziekenhuis. Each year, the fund allocates €600,000 to support ten innovative projects that use technology in smart ways to advance the healthcare of tomorrow. PIHC brings clinicians and researchers together to develop new technologies for improved patient care, or to explore new medical applications for existing technologies.