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Teaser, summary, work performed and final results

Periodic Reporting for period 1 - NEXIS (Next generation X-ray imaging system)


Stroke is the third most common cause of death in the developed world and the leading cause of acquired neurological disability. The current workflow is far from ideal because transportation of the patient to the CT scanner for diagnosis and from there to the interventional...


Stroke is the third most common cause of death in the developed world and the leading cause of acquired neurological disability. The current workflow is far from ideal because transportation of the patient to the CT scanner for diagnosis and from there to the interventional room for treatment takes unnecessarily long time. NEXIS targets a photonics driven breakthrough in image quality of an interventional X-ray system to allow stroke diagnosis directly in the treatment suite.
The overarching NEXIS project objective is to develop and integrate a novel spectral X-ray detector including the related advanced image processing in an interventional X-ray system and to evaluate the clinical performance of the achieved spectral CT-like imaging capability for stroke diagnosis.

A photonics driven breakthrough in image quality and functionality of an interventional X-ray system will allow to perform stroke diagnosis directly in the treatment suite and have a huge impact: enhanced work flow, reduced diagnosis & treatment time (up to 50% time reduction) which will save people’s life and reduce healthcare costs.
NEXIS will establish enhanced contrast Cone Beam CT imaging while keeping high spatial resolution for 2D image guidance by an innovative spectral X-ray detector and related image processing (including deep learning). Two new key photonic components will be developed: 1) A novel thin foil based image sensor that will be optimized to realize a multi-layer detector showing high-end performance for both, spectral and non-spectral X-ray imaging. 2) A 3D printed pixelated CT-like scintillator with high spatial and temporal resolution to enable fast Cone Beam CT imaging without image artefacts. The usability and applicability of the new spectral NEXIS X-ray system for stroke imaging will be clinically validated in a European top hospital.
The project brings together a multidisciplinary consortium, involving the full value chain (photonics R&D, medical system integrator, application owner, supply chain and equipment manufacturing). It will allow key players in the European medical photonics industry to generate sales and stay competitive by providing new X-ray imaging modalities and EU based manufacturing. NEXIS will strengthen European competitiveness by developing a spectral Detector-on-Foil technology that meets the needs of the European and global X-ray image detectors market. In the coming decade NEXIS is expected to initiate the transition of standard (black&white) to spectral (colour) X-ray detectors, which will improve performance and functionality of X-ray imaging systems.

Work performed

The main activities of the consortium during the first project period were to work together towards the main concepts of the project, down to detailed specifications. These common activities were also typical subjects for break-out sessions during the regular face to face consortium meetings. The objectives related to these activities that were achieved in the first reporting period are:
• Definition of clinical requirements, architecture and design for the system in Karolinska (investigational device and glass based detector)

• Definition of requirements, architecture and design for the foil based demonstrators (Detector on Foil, Image Sensor on Foil and 3D printed scintillator)

• Exploration of clinical requirements for the (spectral) algorithms. Full physical modelling and simulations to facilitate the discussions and to enable early evaluations of the algorithms

The next objective that was achieved (not fully yet in this reporting period) is the prototyping of the different hardware and software components and their first technical validations on component level, followed by (sub) integration of components and technical validations (WP2, WP3, WP4, WP5) up to first integration steps on system level (WP6).

From managerial point of view an objective was to facilitate the co-operation of the consortium and co-ordinate and lead the overall project towards the final goal of stroke diagnosis in the interventional room (WP8) using the power of innovative photonics (WP2, WP5) with related processing (WP3, WP4) and following the clinical leadership of the Karolinska team (WP6).

Final results

The global X-Ray Detector Market is expected to reach $3.6B by 2024 from $2.3B in 2016, at a CAGR of 6.0% in the forecast period 2017 to 2024 [Link6]. This market consists of five different application domains (medical, dental, security, veterinary and industrial), of which medical has by far the largest market share (67%). This implies a combined market of 2.4 B$ for medical X-ray detectors in 2024. This market is globally divided in 10% dynamic detectors (240 M$, mainly used in IR X-ray systems) and 90% static detectors (2160 M$, mainly used in Diagnostic Radiology (DR) X-ray systems).

NEXIS detector
At the end of 2020 NEXIS will provide the innovative detector. Trixell will take the next steps to bring the system towards production, the market introduction is planned in 2024. The manufacturing of the detector system will be in Europe (Trixell, Moirans, France) and the 3 partners involved in the Trixell joint-venture (Thales Electron Devices, Philips Healthcare and Siemens Healthcare) will all profit from the availability of the state of the art, innovative NEXIS detector. Overall the market perspective for this type of detector is very good, this is quantified below.

We estimate that in 2025 the directly addressable market of NEXIS is ca. 10% (700 M$) of the global fluoroscopy and C-arm X-ray imaging system market. With a 10% yearly increase of NEXIS penetration, this adds up to a total of ca. 50% (ca. 4 B$) market presence of NEXIS-based X-ray systems in 2030. Assuming that the dynamic X-ray detector constitutes on average ca. 10% of the total NEXIS X-ray system value, this implies a global NEXIS detector market of 70 M$ in 2025 and $400 M$ in 2030. As mentioned before, we expect that NEXIS-based spectral static X-ray detectors will also be introduced in the much larger market of DR (static) X-ray systems from 2025 onwards.

Impacts on employment in the manufacturing regions
The NEXIS results will have a direct positive impact on labour at production sites from Trixell and its partners in the European supply chain. Development and manufacturing of innovative NEXIS X-ray detectors and systems in Europe will prevent this additional employment to move to Asia and US where IR and DR X-ray competitors are very innovative as well. Furthermore competitiveness of European healthcare industry will be strengthened by developing innovative products and services that meet the growing needs of the European and global X-ray image sensors markets.

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