Manuel Desco: “ITEMAS initiated a cultural change in hospitals by promoting innovation and technology transfer”.

Manuel Desco has the Degree and PhD in Medicine and is Nuclear Medicine Specialist and Telecommunications Engineer. He is currently Professor of Bioengineering at the Carlos III University and Head of the Department of Experimental Medicine and Surgery at the Hospital General Universitario Gregorio Marañón. He also leads the Advanced Imaging Unit at the CNIC (Centro Nacional de Investigaciones Cardiovasculares). Dr. Desco works in the field of medical imaging and in the promotion and support of innovation and technology transfer from hospitals.

The health crisis resulting from Covid-19 has transformed our society. How have these transformations been perceived at the medical level? What have we learned from the pandemic?

The pandemic has had an enormous impact on the health system. In addition to the obvious effects on the increased workload, it has allowed us to realise that in Spain we have practically no biomedical industrial sector. Measures are now being put in place to try to boost this biomedical, biotechnological and electromedical sector which, as I have said, was almost non-existent in Spain. We have also seen that we have a much more rigid system than we thought to be able to adapt to a rapidly changing situation. In fact, we have been able to do so, because in Spain the response to critical situations is always good thanks to almost heroic personal efforts, but not thanks to the structure we had, which was by no means ideal for dealing with crises.

At the Gregorio Marañón Hospital you work with various molecular imaging techniques. How will these techniques for interpreting image data allow for the development of biomarkers for patient monitoring in different pathologies (oncology)?

It is not enough; we have known this for a long time. The concept of molecular imaging consists of obtaining a series of images of the human body that contain not only anatomical information, but also information on how different biological processes are working at the molecular level. What defines molecular imaging is that we inject a substance that we can call a probe or tracer, marked in some way so that we can track it from the outside. Depending on what this substance is, we will be able to analyse different metabolic processes in quite different pathologies. The amount of information that can be obtained is enormous and remarkably interesting. However, in order to use these molecules (which have to be injected) in clinical practice, they need to be authorised as a drug, which involves enormous costs and difficulties. Nevertheless, they are an enormously powerful and useful tool in preclinical research and are slowly moving into clinical use. For example, a molecule called FDG, which is glucose labelled with a radioactive atom, can be analysed by an imaging technique called PET (Positron Emission Tomography), and it has been a turning point in the field of oncology.

You mentioned that interesting information could be extracted? What do you mean?

It is interesting information for several reasons. First, because it is quantitative, unlike conventional radiology where the doctor sees the X-ray and there the patient has a tumour, or does not have a tumour, and it is written in the report. Here we get quantitative information that precedes the anatomical changes. When a pathology occurs, it starts to happen on a small scale, on a molecular level, on a cellular level, and little by little it grows. Then, when it becomes visible in a conventional radiological image, the problem already has a macroscopic dimension. However, with these molecular imaging tools we can see things at a much earlier stage. That is, when nothing is visible yet, there is no lump and there is apparently no external sign, molecular imaging can already indicate to us that things are happening at the metabolic level, which are perfectly detectable by these molecular imaging techniques. Molecular imaging, therefore, offers great advantages over conventional anatomical imaging.

There are many changes in the radiology field, how is radiomics revolutionising this sector?

Radiomics aims to overcome the paradigm of qualitative interpretation of images as if they were “photographs”, to enter something more sophisticated, quantitative, where we are able to provide numbers and objective information from what was previously simply “looking at the picture” and saying what we think. In this sense, the contribution of Artificial Intelligence techniques is important.  Right now, there is a total boom, 70% of what is published in our field uses Artificial Intelligence; however, if we look at the clinical field, there are rather few real applications of artificial intelligence. We have a problem of mismatch between the possibilities of radiomics and artificial intelligence tools and what we can implement and exploit safely at the moment in the medical world. What is needed here is not so much technical development as coordination and validation, to see how we are going to be able to transfer these things to the world of clinical reality.

From the UMCE (Unit of Experimental Medicine and Surgery) that you have been directing since 2007, what research is currently being developed and does this research get enough funding through national and international grants? What is needed to carry out this research?

The Experimental Medicine and Surgery Unit of the Gregorio Marañón Hospital is a unit that houses all the central non-clinical research facilities of the hospital, and in which various research groups do a wide variety of things. In the field of imaging, what I would emphasise about the research we are doing now is this orientation towards the practical use of our developments, which was perhaps not so marked before. On the other hand, the funding you are asking me about is obviously scarce if we compare it with other countries, but the worst thing is not the quantity but the quality, because the funding that there is, it’s broken up into a multitude of public, private and different calls for proposals, more or less incompatible with each other, of relatively little economic substance and with enormous rigidities in order to be able to dispose of the funds in a sensible way. In the United States, for example, million-dollar projects are awarded; the researcher writes up his or her project and, if it is awarded, has the next few years to work continuously and consistently. In Spain, instead of granting us a project of six million euros for us to work on for the next three or five years, they give us a project of 50,000, another of 100,000, another of 7,500 euros, which forces us to spend our lives writing applications for new projects, trying to finance in bits and pieces what should have been a large and consistent funding. There was an initiative that was the creation of the State Research Agency to unify and rationalise funding sources, but clearly this has not yet been achieved and we still have a long way to go.

What is the current state of biomedical engineering and what are the main technological advances in this field?

Biomedical engineering is a recently created Degree in Spain. In fact, at the Carlos III University we launched one of the first Biomedical Engineering Degrees in Spain, but that was only a few years ago. We have joined something that has been around for a long time all over the world, and I am not just talking about very advanced countries. However, in a few years we have created 17 biomedical engineering degrees. We have gone from having absolutely nothing to a proliferation of graduates, perhaps too many for the foreseeable demand. Biomedical engineering is particularly important in the field of hospitals, not only in research, but also in daily care because hospitals are becoming more and more technological, they are full of instrumentation and a team of people who understand this instrumentation is needed, through a professional figure called “clinical engineering”.  At the Carlos III University we have launched a Master’s Degree in Clinical Engineering, the first in Spain to deal specifically with this professional profile and, although there is a clear demand today, I hope that we do not also fall into an overproduction of clinical engineers and do not know what to do with them.

Diagnostic imaging is becoming increasingly important in medicine. Do you think that the presence of biomedical engineering specialists in hospitals is adequately represented?

If we think of biomedical engineers in general terms, who can participate in the healthcare activity, we are clearly far behind. In hospitals, there is no concept of an integrated engineer in what is strictly speaking the care circuit. In the field of clinical engineering, there are more professionals working, because the need for engineers specialised in hospital instrumentation is obvious. But biomedical engineers can work not only in hospitals, in the field of industry they also have a wide range of potential professional positions in the development and management of all the instrumentation used in hospitals.

In Spain, top-level biomedical research has been carried out in recent years, in addition to the work of transferring this research to the market. What is the involvement of hospitals in this transfer? Can this transfer represent an important source of income that will help the sustainability of the health system?

Our country has an enormous lack of innovation and a large gap between science and the generation of knowledge and the use of the knowledge we have generated. Some public institutions, such as the Carlos III Health Institute, decided years ago to create a platform called ITEMAS, to stimulate and facilitate innovation and transfer processes in hospitals, so that scientific work does not simply renders an article but becomes something real that generates value for society. This initiative has brought about a marked cultural change with regard to innovation in hospitals over the past ten years; there is now a better understanding of what innovation is, it is understood that the scientific article is a step along the way, not the end, and the fact that we have been able to set up structures in hospitals to support innovation and technology transfer has been decisive in enabling us to experience an increase in innovation projects and successful results. On the other hand, rather than talking about income, I would talk about generating value, which could be through income if we have licensed some technology that produces economic returns, but it is not the only way to generate value, it can also be done by reducing costs, optimising processes, or simply allowing the funding of new research projects in collaboration with industry. I believe that this public-private collaboration and this integration of research and industrial needs is absolutely necessary.

What role do platforms like ITEMAS play in technological progress and innovation?

I was the coordinator of ITEMAS for ten years and the truth is that I am very happy with that period of my life. Ten years ago, when the word innovation was mentioned, almost nobody knew what it was; when we talked about patents it seemed that it was something that was done abroad (remember the famous “let them invent it”), and when we talked about transfer to industry it was a strange thing because in Spain there was very little tradition of technology transfer and entrepreneurship. This has changed a lot in the last ten years, and now the innovation support units are entities that everyone in the hospital knows and play a very important role, with more and more projects and more and more staff. I would go so far as to say that ten years ago university academia was more advanced than hospitals in terms of technology transfer, but now it is the other way around.

In surgery, interesting projects are also being developed at an experimental level. What challenges does surgery face in the future?

Technology is entering surgery everywhere, from robotic surgery, computer and image-guided surgical navigation systems, 3D printing of surgical tools, and so on. But it’s also true that this surge of biomedical engineering technology is seen in all areas of medicine, from the surgery you are asking me about, to the laboratory, to conventional clinical medicine, to diagnostic tools, to imaging, and so on.

What are your main achievements in your long medical career: both in healthcare medicine and in the business and research aspect of biomedical imaging?

I can certainly say that I have been able to work in what I liked, and in that sense I am happy. Perhaps I have been changing my profile throughout my life because at the beginning I was more focused on research and knowledge generation, and as time went by, I discovered business and entrepreneurship, which helped me to learn a lot. Lately, since I joined the university to contribute to the implementation of this whole field of biomedical engineering at the Carlos III, I have the feeling that the most important or most relevant thing I can do at this point in my life is to train new good professionals and try to leave the structure a little better than it was when I arrived.

What scientific work would you highlight from the more than 570 publications in which you have participated or the almost 100 national and international research projects?

The most noteworthy are perhaps those works that have not been a mere contribution to knowledge, but which have later become tangible products, which in some cases have been sold around the world and which have allowed me to finance my research group. I find it interesting to be able to combine scientific work with the generation of innovation and the attainment of funding not only from the public sector but also through industrial returns, that is, from things that have been done and work.

You are now part of the Business Advisory Board of GENESIS Biomed, how do you think you can contribute with your experience to the projects we are working on and how do you value this type of initiative?

I believe that GENESIS Biomed is an initiative that covers a need we had in the country, a bridge company for the transfer of knowledge that is generated in academia and in hospitals and that has to be put into practice. It is an extraordinarily complex journey where you have to have professional help, because this management is enormously difficult. Companies like GENESIS Biomed, which know very well how to make the transition from the world of ideas to the world of reality, are essential and can be the secret of success in many projects. Since I got to know GENESIS, I have been delighted; at the hospital we count on them every time we have a complex project with good possibilities for the future. They recently invited me to participate in their Business Advisory Board, in the modesty of what I can contribute, which is being in this field for many years and have made many mistakes, and perhaps have a very multidisciplinary background, so that in some projects my point of view may be interesting for this board that advises GENESIS