FlyTitle: Cardiology

How virtual copies of patients’ hearts could help doctors diagnose and treat cardiac disease

病患心脏的虚拟副本将帮助医生诊断和治疗心脏病

经济学人双语版-心脏的数字孪生体 The heart’s digital twin

IF YOU TRAVEL on a modern airliner, the chances are that each of the jet engines powering it will have a virtual copy residing in a computer on the ground. This copy, known as a digital twin, will be updated constantly with information from sensors that measure the engine’s performance and check for signs of wear and tear. Digital twins allow engineers to service engines as and when needed, rather than sticking to rigid schedules, and let them carry out preventive maintenance by fixing things before they break. Their use is increasingly common—not only in aerospace, but also in carmaking, construction and factory planning. If an international team of researchers have their way, similar twins will soon keep an eye on another important piece of equipment, the human heart.

如果你乘坐现代客机出行,为它提供动力的每个喷气发动机可能都会有一个虚拟副本,驻守在地面上的一台计算机中。这个副本被称作“数字孪生体”,会根据传感器传递的信息不断更新,这些传感器测量发动机的性能,检查磨损的迹象。有了数字孪生体,工程师就不用遵照严格的时间表去检修发动机,而可以在有需要时再维修,还可以做预防性维护,在发生故障前就纠正问题。它们的应用越来越普遍——除航空航天外还用在了汽车制造、建筑和工厂规划等领域。如果一个国际研究小组能如愿以偿,类似的数字孪生体还将很快被用来密切关注另一种重要的“设备”:人类的心脏。

Building a digital twin of a patient’s heart would first require that person to don a variety of sensors. The data from these would then be turned by specialised software into a computer simulation of the pumping organ. This simulation would show detailed information about how the heart is working, and the way blood is flowing within it. And, in the same way that digital twins in industry are employed by engineers, virtual hearts could be used by doctors to help with their diagnoses and to determine what treatments might be necessary. A twin could then keep track of how a patient responded to those treatments.

要为患者的心脏创建一个数字孪生体,首先需要让这个人戴上各种各样的传感器。之后,专门的软件会把来自传感器的数据转换成心脏的计算机模拟。这个模拟会详细展示心脏的工作状态以及血液在其中的流动。而且,就像工程师在工业领域对数字孪生体的运用那样,医生或许也可借助虚拟心脏的帮助来做出诊断,并确定哪些治疗可能是必要的。数字孪生体后续还可以跟踪患者对这些治疗手段的反应。

Heart of the matter

问题的核心

The idea of creating digital heart-twins comes from a cardiac-research programme called ECHOES, led by Frank Rademakers of University Hospitals Leuven, in Belgium. Several European and American research groups are involved, including the Universities of Sheffield and Bristol in Britain and, in America, Harvard and Stanford, along with firms such as ANSYS, a computer-simulation company, and GE, which makes jet engines and medical devices.

创建数字心脏孪生体的想法来自心脏研究项目“回声”(ECHOES),由比利时鲁汶大学医学中心的弗兰克·雷德梅克斯(Frank Rademakers)领导。参与者有欧洲和美国的若干研究小组,包括英国的谢菲尔德大学和布里斯托大学、美国的哈佛大学和斯坦福大学,以及计算机模拟公司ANSYS和喷气发动机及医疗设备制造商通用电气等企业。

An important part of ECHOES is the development of miniaturised sensors that will allow people to wear the monitoring equipment throughout their daily lives, rather than just in a clinic or a doctor’s surgery, says Tim Chico of the University of Sheffield, who leads the British arm of the project. This will permit heart function to be simulated in a variety of circumstances, including walking, sleeping and climbing stairs, rather than just for the brief period when a patient is undergoing clinical examination. Although some portable cardiac devices are already available—small electrocardiographs worn on a belt, for example, with leads that attach to a patient’s chest to trace the rhythm and electrical activity of the heart—these tend to be used for just a couple of days. Digital twins would draw data from a broader suite of sensors, and for longer.

谢菲尔德大学的蒂姆·奇科(Tim Chico)负责该项目的英国分支。他说“回声”项目的一个重要内容是开发微型传感器,让人们能在日常生活中始终佩戴监测设备,而不是只在诊所或医生的诊室内佩戴。这样就可以在患者行走、睡觉和爬楼梯等各种情况下模拟心脏的功能,而不局限于他们接受临床检查的短暂时间内。尽管现在已有一些便携式的心脏检测设备(例如装在腰带上的小型心电图仪,通过贴在患者胸部的导线追踪心律和心脏电活动),它们往往只能使用几天。数字孪生体会从一套更多样的传感器中获取数据,工作的时间也更久。

Some of the monitoring could be done by existing or adapted consumer products, such as health apps on smartphones and fitness trackers, adds Dr Chico. Other sensors, with more sophisticated capabilities, are being developed by ECHOES’ members. These include a wearable ultrasound scanner which Jan d’hooge and his colleagues at the University of Leuven are working on. An ultrasound scanner is a device that employs high-frequency sound waves to create images of parts of the inside of the body. The idea, says Dr D’hooge, is that both the transmitters which produce the ultrasonic pulses and the receivers which pick up the returning echoes can be woven into textiles used to make items of clothing, such as vests. He is optimistic that it will thus be possible to create garments capable of conducting heart scans, and that these might be washable.

奇科补充说,部分监测工作可由现有的或改造过的消费产品来完成,比如健身追踪器和智能手机上的健康应用。“回声”项目的成员正在开发其他功能更先进复杂的传感器。其中一种是简·德胡奇(Jan D’hooge)和他在鲁汶大学的同事正在研发的可穿戴超声波扫描仪。超声波扫描仪利用高频声波来生成体内器官的图像。德胡奇说,他们的想法是,也许可以把产生超声波脉冲的发射器和接收回波的接收器织进布料里,再做成衣服,比如背心。他乐观地认为,这样就可能制造出能够进行心脏扫描的服装,而且这些衣服说不定还可以清洗。

All this would help cardiologists like Dr Chico a lot. It is often hard for patients to describe their symptoms fully, and hospital tests might not reveal a complete picture—especially as people tend to be under stress when those examinations are carried out. To start with, the data used to model and update a digital heart-twin will be recorded by the collection device and uploaded therefrom at intervals. Eventually, though, it should be possible for them to be transmitted directly to a medical centre, just as data from a jet engine are transmitted to an engineering base.

这一切将会对奇科这样的心脏病专家大有助益。患者通常难以全面地描述自己的症状,医院的检查也可能无法揭示完整的情况——特别是人们在接受检查时往往会感到紧张。首先,用于模拟和更新心脏数字双胞胎的数据将由采集设备记录,并定期上传。不过最终这些数据应该可以直接传送至医疗中心,就像把喷气发动机的数据传送到工程基地一样。

While wearable heart scanners are several years away, some elements needed to build digital heart-twins are close to deployment. Rod Hose, a former aerospace engineer who is now an expert in medical modelling at the University of Sheffield, led a recent project called EurValve, which developed a system to help doctors treat people with heart-valve disease. EurValve gathered a variety of data about patients’ conditions from scans and other hospital tests, and combined these with other information acquired from those patients when they were at home, via health-tracking watches produced by Philips, a Dutch technology group. The EurValve system, which the researchers hope will soon be put into clinical practice, can model the severity of disease and predict the outcome of heart-valve-replacement surgery.

虽然可穿戴式心脏扫描仪还要几年才能问世,但构建心脏数字孪生体所需的部分元素已经接近部署阶段。曾经是一名航天工程师、现在是谢菲尔德大学的医学建模专家的罗德·霍斯(Rod Hose)近期领导的EurValve项目开发了一个系统,可协助医生治疗心脏瓣膜疾病。EurValve从扫描结果和其他医院测试中收集关于患者病情的多种数据,并将它们与这些患者在家中通过荷兰科技集团飞利浦生产的健康跟踪手表获得的其他信息结合起来。EurValve系统能够对病情严重性建模,并预测心脏瓣膜替换手术的结果。研究人员希望它能很快被应用于临床实践。

A digital twin of the whole heart will allow simulation of the treatment of a particular individual for many other conditions, as well. That will give a clearer idea, in a particular case, of the likely outcome of an intervention. It might show, for instance, what type of operation is best suited to a patient’s condition, or if drugs and regular check ups are more appropriate.

此外,通过整个心脏的数字孪生体模拟还可以模拟对特定个体所患的其他多种疾病的治疗。医生将会更清晰地了解在某个病例身上实施某种干预手段可能产生的结果。例如,数字栾生体也许能显示哪种手术最适合患者的病情,还是说药物和定期检查更合适。

As more and more patients have their heart twins analysed, machine learning, a form of artificial intelligence that is good at pattern recognition, will be used to study the outputs. This should make the system yet more accurate, and help with unusual and rare cases that a cardiologist might not have seen before. Just as pilots can relax knowing that a digital twin is keeping an eye on their engines, doctors will benefit from a new depth of knowledge about how their patients’ hearts are working. ■

随着越来越多患者的心脏孪生体接受分析,机器学习这种擅长模式识别的人工智能将会被用来研究分析结果。这应该会让这个系统变得更精确,还可以帮助心脏科医生诊治他们也许从没见过的不寻常和罕见病例。飞行员可以放松许多,因为知道有个数字孪生体正盯着引擎。同样,更深入地了解患者心脏的工作状况也会让医生获益。