Robotic surgery (and AI and 3D printing and the Canadian Senate


Traditionally known as the chamber of sober second thought, one does not expect to look to the Canadian Senate for visionary work on the future of health care in Canada.

But that’s exactly what the Senate Standing Committee on Social Affairs, Science and Technology produced last week in “Challenge Ahead: Integrating Robotics, Artificial Intelligence and 3D Printing Technologies into Canada’s Healthcare Systems.”

The report received little attention on its release but is a fascinating summary of hearings held by the Senate committee on these new technologies based on interviews with a number of experts including prominent medical futurist Dr. Bertalan Mesko (@Berci) and Canadian physician and 3D printing researcher Dr. Julielynn Wong (@JulielynnWong)

“Amazed, humbled and overwhelmed” were the words the senators used in describing the potential impact of robotics, artificial intelligence (AI), and 3D printing on the future of health care in Canada. “Committee members were amazed at the innovations that were presented during the course of this study, humbled by the ingenuity on display and overwhelmed by the potential impact these disruptive innovations can have on the healthcare system.”

The report contains brief overviews of the status of each of these technologies and described how Canada has been in the forefront of their development for use in healthcare.

The report stated: “The innovative technologies addressed in this report are ones that offer, or have the potential to offer, person-centred healthcare. Whether that is a 3D model of a patient’s diseased organ, an AI diagnosis based on a patient’s specific symptoms and circumstances or a robotic arm that responds to a user’s unique needs, these technologies will play an important role in the future of training and education, services to rural and remote regions, home care and personalized medicine.”

Screenshot (325)   The report said Health Canada has indicated current regulations governing medical devices are appropriate for dealing with these new technologies, but added “members were told that in the case of some of the innovative technologies, traditional randomized, controlled trials may not be the most appropriate approach and that the regulator should allow alternative approaches to determine safety and efficacy.”

Some caveats were also mentioned and discussed in the report:

“Despite the enormous potential that rests with these technologies, members were struck by the need to be aware of some unintended consequences of integrating them into healthcare delivery. Concerns included ethical considerations, the impact on employment, difficulties in commercializing innovations, needed adjustments to training and education and updating the regulatory framework for medical devices,” the report concluded. “In order to be successful in integrating robotics, AI and 3D printing into healthcare delivery, Canada has to address the hurdles that lie in the way.”

The bottom line for many witnesses was that if healthcare workers and patients are presented with options that provide better outcomes, they will embrace them.

The report concluded by making a few recommendations beginning with a call for the federal government to convene a National Conference on Robotics, Artificial Intelligence and 3D Printing in healthcare.

(Senate photo copyright Saffron Blaze)


(A) I, Radiologist

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Born of the discovery of the x-ray by Wilhelm Roentgen in 1895, the specialty of radiology is suddenly facing perhaps its greatest challenge with advent of artificial intelligence (AI) and machine learning.

Radiologists who have adapted to all manner of new diagnostic modalities over the generations now find themselves facing the prospect of machines which read and interpret imaging results quicker and more accurately than they can.

The Canadian Association of Radiologists (@CARadiologists) recently held its 80th annual meeting in Montreal and among the posters was one advertising that next year’s meeting would focus on AI. One wonders, given the speed with which AI and other technologies such as 3D printing are transforming radiology and medicine in general, whether next year is maybe too late to grapple with the issues raised.

The program committee of the CAR may have unconsciously acknowledged this as many sessions at this year’s meeting dealt with advanced technologies and at least two speakers dealt directly with the future role of the radiologist.

In addition, one of the highlights of the exhibit hall was IBM Watson Health (@IBMWatsonHealth). Last year, IBM created the Watson Health medical imaging collaborative, a global initiative with more than 26 leading health systems, academic centres, and imaging companies (they are currently looking Canadian participants) to bring cognitive imaging into daily practice. Earlier this year, IBM launched the Watson Imaging Review to reduce practice-pattern variation and reconcile differences between a patient’s administrative record and his or her clinical diagnosis.

One of the IBM staff was heard telling a CAR delegate, Watson “is not here to take your job away, it’s here to make your job easier.”

Presentations on AI and machine learning were matched by discussions of 3D printing, another technology currently transforming radiology and health care delivery.

Dr. Frank Rybicki, chief of radiology at the University of Ottawa and chief of medical imaging at The Ottawa Hospital, gave a comprehensive overview of how 3D printing is transforming many areas of medicine. The Ottawa Hospital recently opened the first 3D printing program based at a Canadian hospital.

Dr. Rybicki predicted that soon every hospital would have such a program as 3D printing moves from niche interventions to a leading role in reconstructive surgery, and cardiovascular and neurological interventions as well as supplying models to improve physician-patient communications and reducing peri- and post-operative complications.

“3D printing is the information delivery system of the current radiology generation,” he said, such as the young radiologists from Memorial University of Newfoundland who presented a paper showing the value of 3D printing of blood vessels to help educate the public and medical students.

It was a past-president of CAR, Dr. Ted Lyons from the University of Manitoba who bluntly outlined the future facing radiologists as a result of all these changes.

He noted that one of the fundamental roles of radiologists – reading and interpreting x-ray film – has almost already totally disappeared with the advent of PACS (picture archiving and communication systems).  By 2035, he predicted, all x-rays, CT scans and MRIs will be read and interpreted by machines.

The way forward for radiologists is twofold according to Dr. Lyons; firstly by becoming more than a “faceless name” who interprets images in a darkened room and being more directly involved and engaged with other clinicians and patients at the bedside. The second fundamental need, he said, is for radiologists to become data scientists and lead the integration of AI into radiology practice.

Dr. Lyons presentation was complemented later in the meeting by a presentation from a SickKids Hospital, Toronto radiologist Dr. Erika Mann who reiterated how radiologists need to become more patient-centred if they wish to remain relevant.