Hidden haemodynamics: A Physics-InfOrmed, real-time recoNstruction framEwork for haEmodynamic virtual pRototyping and clinical support (PIONEER)

个性化护理，即根据人们的个人健康需求量身定制治疗建议，一直是医学史上临床医生的目标。但在此之前，设计干预措施并预测我们的身体对这些干预措施的反应是不可能的。随着我们将先进的成像、建模和仿真等新方法结合在一起，新的可能性正在出现。NHS长期计划将心血管疾病确定为临床优先事项，也是NHS在未来10年内可以挽救生命的最大单一疾病。目前，仅在英格兰，每年就有超过43000例经常挽救生命的血管干预，由于人口老龄化和合并症的增加，预计会增加。许多这些干预需要手术和/或永久性和个性化的血管植入物。血管外科医生依靠高超的技术和天赋来进行一些最复杂的（和生命攸关的）干预；另一方面，患者一生都依赖于这些干预措施是安全的或高效的。但是我们怎么知道会是这样呢？这些干预措施是最佳的吗？在正确的时间对正确的病人进行正确的干预（通常是外科手术），即精确的血管手术，到目前为止一直是一个无法实现的目标。为了实现这一目标，我们需要革命性的工程技术，与目前使用的技术根本不同。为了使未来的血管手术成为现实，我们需要开创性的工作，能够以可接受的现实水平预测个性化血管干预的未来结果，足够快，可以在短时间内探索多种可能性，并且足够值得信赖，从而获得临床从业者的信任和信心。血流（血流动力学）在大多数血管疾病的发生和发展以及干预的临床结果中起着关键作用。然而，在常规临床实践中，血流动力学信息并不容易获得——尽管医学成像技术取得了进步——在常规临床实践中，各种成像方式被常规使用。更关键的是，成像数据只能给我们现在的信息，而不是未来的信息；它们无法告诉我们，任何特定（通常是个性化）干预的结果将是什么。在这个案例中，工程工具可以通过提供血管疾病的血流信息来发挥真正的作用，这些信息不能在体内测量，更重要的是，通过创建潜在干预措施的计算机模型，以及它们的结果。通过融合计算血流模型和成像数据，我们可以在临床术前计划和个性化治疗方面取得真正的突破。在PIONEER中，我们计划开发最复杂的物理驱动计算工具，从常规使用的血管成像数据中实时提取准确的非定常和三维血流动力学信息（速度和压力）。这些信息将用于个性化心血管干预和心血管设备定制的血流动力学虚拟原型。这项工作将使精确血管手术向前迈出根本性的一步，并将为血管外科医生的决策过程提供专家支持，从而显著改善个体患者的风险管理。为了实现这一愿景，我们将与国内三家顶级医院（皇家自由医院、巴茨医院和GOSH）、两个患者团体（AVM蝴蝶慈善机构和主动脉意识英国）和一家领先的医疗设备公司Terumo Aortic协同合作。首先，我们将共同创建一个概念验证，为将我们的突破性技术引入临床和制造工作流程铺平道路。

Personalising care, i.e. tailoring therapeutic recommendations to people's individual health needs, has always been a clinicians' goal throughout the history of medicine. But never before has it been possible to design interventions and to predict how our bodies will respond to those. New possibilities are now emerging as we bring together novel approaches, such as state-of-the-art imaging and modelling and simulation. The NHS Long Term Plan identifies cardiovascular disease as a clinical priority and the single biggest condition where lives can be saved by the NHS over the next 10 years. There are currently over 43000 often life-saving vascular interventions p/year in England alone, predicted to increase due to an ageing population and rise in co-morbidities. Many of these interventions require surgery and/or permanent and personalised vascular implants. Vascular surgeons rely on superb skill and flair to perform some of the most complex (and life-critical) interventions; patients, on the other hand, rely on these interventions being safe or high-performing, for a lifetime. But how do we know that this will be the case? That these interventions are optimal? Getting the right intervention (often, surgical) to the right patient, at the right time, i.e. precision vascular surgery, has until now, been an unachievable goal. To realise this goal, we require transformative engineering technologies, fundamentally different from those used today. For the vascular surgery of the future to become a reality, we need pioneering work able to predict the future outcome of an individualised vascular intervention with an acceptable level of realism, fast enough to allow the exploration of multiple possibilities in short periods of time, and trustworthy enough such that they elicit trust and confidence from clinical practitioners. Blood flow (haemodynamics) plays a pivotal role in the initiation and progression of most vascular conditions and the clinical outcomes of interventions. However, hemodynamic information is not readily available in routine clinical practice -despite advances in medical imaging- where a variety of imaging modalities are used routinely. More crucially, imaging data can only give us information about the present, not the future; they cannot tell us what the outcome of any given -often personalised- intervention will be. Here is a case where engineering tools can make a real difference by providing blood flow information for vascular diseases, that cannot be measured in vivo and more importantly, by creating computer models of potential interventions, and their outcomes. By fusing computational blood flow models and imaging data we can make a real breakthrough in clinical pre-operative planning and personalise treatment.In PIONEER we plan to develop the most sophisticated, physics-driven computational tools that will extract, in real-time, accurate unsteady and three-dimensional hemodynamic information (velocity and pressure) from routinely used vascular imaging data. This information will be used for haemodynamic virtual prototyping of personalised cardiovascular interventions and tailoring of cardiovascular devices. The work will enable a fundamental step forward towards precision vascular surgery and will provide expert support for vascular surgeons in their decision-making process, leading to a dramatic improvement in the management of individual patients' risk. To catalyse this vision, we will work synergistically with three top hospitals in the country (Royal Free Hospital, Barts Hospital and GOSH), two patient groups (AVM Butterfly Charity and Aortic Awareness UK) and a leading medical device company, Terumo Aortic. Together, we will firstly create a proof of concept that will pave the way to introduce our ground-breaking technology in clinical and manufacturing workflows.