null Perception is everything when it comes to the heart

McGill startup is developing an innovative mixed reality platform to support surgeons

Cofounders of Holo-Ray: postdoctoral fellow Amir Hooshiar, PhD (Injury Repair Recovery Program, RI-MUHC), scientist Renzo Cecere, MD (Cardiovascular Health Across the Lifespan Program, RI-MUHC) and research assistant Amir Sayadi (Surgical Robotics Centre, RI-MUHC); image by Owen Egan.
Cofounders of Holo-Ray: postdoctoral fellow Amir Hooshiar, PhD (Injury Repair Recovery Program, RI-MUHC), scientist Renzo Cecere, MD (Cardiovascular Health Across the Lifespan Program, RI-MUHC) and research assistant Amir Sayadi (Surgical Robotics Centre, RI-MUHC); image by Owen Egan.

By Diane Lynn Weidner

SOURCE: Steinberg Centre for Simulation and Interactive Learning. An interdisciplinary startup at McGill is leveraging their combined expertise to develop Holo-Ray, an integrated, cloud-based platform that will allow surgeons to quickly generate 3D holographic anatomical models from a patient’s diagnostic imaging scans.

This immersive mixed-reality technology will be used for education, diagnosis and treatment planning for minimally invasive interventional procedures. At the moment, the team is focusing on the cardiovascular system, but this technology has the potential to be used on different anatomical structures.

One of the three co-founders and Chief Medical Officer at Holo-Ray is Renzo Cecere, MD, a heart surgeon renowned for his expertise in novel cardiac assistive devices. He is Associate Professor in the Department of Surgery at McGill University, Director of Cardiac Surgery at the McGill University Health Centre and a scientist in the Cardiovascular Health Across the Lifespan Program at the Research Institute of the McGill University Health Centre (RI-MUHC).

When we met, Dr. Cecere had just spent the morning performing a full sternotomy. This procedure involves cutting through a patient’s breastbone and opening up the rib cage to provide access and visibility on the patient’s heart and nearby organs. However, as he explains, the current trend is to minimize the open surgical approach in cardiology as these large incisions have a higher risk of complications and longer recovery times.

When possible, surgeons perform minimally-invasive interventional procedures that involve inserting a catheter through the various access points in the body to get to the heart, relying on medical imaging to provide visual guidance.

“But you have to first and foremost do a perfect job,” says Dr. Cecere. “To gain the advantage of a catheter-based approach, you have to see what you’re doing. Remember, the heart is inside the body; it is a moving structure that’s filled with blood, so you can't just insert a camera and look at it. If we rely on the old-fashioned radiographic images, we’re very limited in what we can do with catheters because we can't really see well enough. We need special modalities for imaging. We need to have artificial eyes to show us what's going on inside.”

Hence the impetus for Holo-Ray, a cloud-based platform that uses different methods of advanced technology and holographic imaging to quickly reconstruct CT (computed tomography) and MRI (magnetic resonance imaging) scans in various ways.

Dr. Renzo Cecere demonstrates the Holo-Ray prototype (Image by Owen Egan)
Dr. Renzo Cecere demonstrates the Holo-Ray prototype (Image by Owen Egan).

“Going back twenty years, surgeons would use indirect means, such as X-rays, to visualize what's going on with the patient,” explains Dr. Cecere, “but X-rays are two-dimensional. They tell you very little about depth and are limited by the angle of the orientation. Perception can change drastically based on the angle. That's very rudimentary and that's what was used originally in surgery.”

“We also looked at coronary angiograms, tests that show you where the blockages are located in your coronary arteries. When I was a medical student looking at coronary angiograms, it was always very impressive to see that the tightness of that blockage could change depending on your view. It was amazing that in one view, there's nothing there, it looks perfect… and then you wait a minute, you click to the next view and all of a sudden, it looks like a 90 per cent blockage. That was our reality at the time, so we were always very careful.”

“That's still true today of those imaging modalities, but now we're a lot smarter and we have different technologies that are better able to assess even something as simple as a coronary blockage. We have ultrasound, and we have pressure transduction which tells us something about the blockage as well—all kinds of different things that supplement the limitation related to the radiographic imaging.”

“Holo-Ray is exciting because it will provide more real perception for surgeons. It uses interesting technology to sort of fool the imaging into seeing the real thing. We can move catheters around inside the heart and visualize angles that weren't approachable before, aided by robotics and mechatronics. We are then able to train these catheters using deep learning artificial intelligence algorithms so that the more the catheter does, the better it gets at going to where it wants to go and the less room for human error,” concludes Dr. Cecere.

They also plan to use this platform for educational purposes, to augment surgical training by providing access to a database of 3D holograms constructed from real patient pathologies and complex anatomical structures, securely protected and anonymized using HIPAA compliant encryption.

Building on the strength of an interdisciplinary team

Holo-Ray’s co-founders attribute the successful development of this novel concept to interdisciplinary collaboration between medicine and engineering, along with strong institutional support and encouragement.

The Chief Technology Officer at Holo-Ray is Amir Hooshiar, PhD, a mechanical engineer with expertise in biomedical devices and surgical robotics whose doctoral studies focused on haptics-enabled robot-assisted surgical systems for cardiovascular intervention. A postdoctoral fellow in the Injury Repair Recovery Program at the RI-MUHC, he joined McGill in June 2021 to lead the development of the new Surgical Robotics Centre.

“McGill’s Department of Surgery has prioritized this surgical robotics initiative because it's moving very fast in the world, and we want to keep up the pace. This is very meaningful to me,” says Mr. Hooshiar, who is eager to build this new centre of excellence that will bring together interdisciplinary teams to foster innovation.

Let’s fly inside the heart together!

Shortly after joining McGill, Mr. Hooshiar and Dr. Cecere crossed paths and quickly discovered a shared common interest. They formed a close collaboration and established a new research program that addresses needs in the area of cardiovascular surgery, medicine and robotics.

Amir Sayadi, a recent graduate of the McGill Experimental Surgery Program, was recruited as the research program’s first PhD student. As the third co-founder and Chief Executive Officer at Holo-Ray, Mr. Sayadi has a background in mechanical engineering with considerable experience in surgical robotics, mixed reality and medical software development.

This former flight simulation technician vividly recalls Mr. Hooshiar saying ‘We’re going to fly inside the heart’ when they first met to talk about how they could leverage their expertise to develop this innovative biomedical device.

“I immediately understood the potential of this new technology and was eager to explore ideas together. I really want to finish this important work, to see it through, because it will support good surgeons and help lots of patients, not just here at McGill but all around the world,” says Mr. Sayadi, who has already led several successful startups in his career.

Moving forward with a solid plan

The Holo-Ray team believes that for successful innovation, it’s important to surround yourself with the right team, to have experienced mentors, and to strike a good balance of expertise and autonomy. They also stress the importance of perseverance.

“Just don’t give up! It takes patience and perseverance to bring a medical device to market. It’s a long process because of the necessary but extensive validation, testing and regulatory requirements that need to be completed as part of the medical device lifecycle, but it’s worth all the effort, and we have very good resources at McGill to help support startups,” says Mr. Hooshiar.

As winners of the Marika Zelenka Roy Simnovation Prize, offered in partnership with the Montreal General Hospital Foundation at the 2022 McGill Clinical Innovation Competition, Holo-Ray is using their cash award and credits to help support the development of this innovative project. In the coming months, they will move forward with proof of concept research studies, and will be raising seed money to support Holo-Ray’s continued growth.

Learn more about the Steinberg Centre for Simulation and Interactive Learning

September 9, 2022