Bowel cancer is the second most-common cause of cancer death in Scotland, with around 1,600 people dying of the disease each year. The current detection method involves inserting an endoscope, a thin flexible tube with a camera on the end, into a patient's colon which then travels around the large bowel allowing doctors to check for cancer.
The new procedure being developed by the research team - known as a Clinical Capsule Endoscopy (CCE) – utilises an artificial intelligence-assisted 'smart pill' containing cameras (pictured below) which, once swallowed by a patient, records images of the intestines as it passes through.
At present, images captured by the capsules are reviewed by trained doctors, but AI offers the potential to safely and ethically speed up the process, make it more cost-effective and increase its use.
Image credit: AICE project
Towards this end, a consortium of 12 partners across Europe has received a €6m Horizon Europe grant to work towards eliminating the current medical, technical and economic barriers to the adoption of AI-supported Image Analysis in Large Bowel Camera Capsule Endoscopy (AICE).
This includes demonstrating that AI algorithms are at least as effective as humans at analysing endoscopy images and identifying where further investigation is required.
The four-year AICE project involves the University of Strathclyde, NHS Highland and Islands and two of Scotland's innovation centres – The Data Lab and the Strathclyde-hosted Digital Health and Care Innovation Centre.
The international collaboration project is being led by the Centre for Clinical Implementation of Capsule Endoscopy at Odense University Hospital, Denmark, and brings together clinical researchers, epidemiologists, data scientists, digital health experts, health economists, ethics researchers, SMEs, communication experts and experts in regulatory affairs.
The multidisciplinary team will cover aspects such as validation and development of algorithms, the creation of a clinical support platform, clinical indications and guidelines, patient engagement, cost-efficiency, ethical considerations and future implementation strategies.
Expected benefits include earlier initiation of treatment; less advanced-staged cancers; fewer complications related to the diagnostic procedure; better patient acceptability and compliance, and a significant reduction in costs from both diagnostics and treatment. It also has potential to reduce the capacity pressures that NHS health boards across the UK are experiencing.
Strathclyde is leading on work to develop and validate patient-reported experience measures for capsule endoscopy, as well as the design and prototyping of a digital patient engagement tool to support participation in the procedure, adherence and report access. Researchers will also develop nine AI algorithms which will be tested and validated in clinical settings in Denmark and by NHS Highland.
Professor Roma Maguire, University of Strathclyde, said: "Capsule endoscopy, particularly AI-assisted, has huge potential to improve the early diagnosis of bowel cancer, but for such an approach to be adopted it has to be acceptable to patients.
"We are developing digital tools that will help us to understand patient outcomes of capsule endoscopy and crucially patients' experience of, and feelings about, this procedure. This is a really pioneering project involving partners from across Scotland who are contributing their expertise."
Brian Hills, chief executive of The Data Lab, said: "This could be gamechanging for early bowel cancer detection, which is so vital in improving survival rates of the disease, with the potential to dramatically benefit healthcare systems right across the country by using AI to help clinicians to spot the early warning signs of this deadly disease and save lives.
"The project demonstrates how Scotland is very much at the forefront of global healthcare innovation. It has the potential to make bowel cancer diagnosis and treatment more cost effective, less invasive and easier for patients than existing procedures."
Professor George Crooks OBE, chief executive officer, Digital Health & Care Innovation Centre, said: "To secure high-quality, safe and effective service delivery, there is a vital need to engage all the relevant expertise from across the clinical, research and technology communities to secure not only the latest technical innovations, but also the clinical service models that serve the needs of patients and clinicians in equal measure.
"This exciting European collaborative will build on work under way in Scotland and inform future diagnostic models by harnessing the use and understanding of AI as a support tool for clinicians in making effective clinical decisions on management, which will deliver significant improvements in the management of patients at risk of bowel cancer."
Professor Angus Watson, NHS Highland, said: "There are many advantages to CCE but the addition of AI will be a gamechanger. In the very near future patients will be able to have a CCE in their own home, AI will enable the images to be reported exceptionally rapidly, so the patient is able to get the result of the test almost immediately. This large European grant will allow AI to become a reality."
NHS Highland was the first health board in Scotland to trial the procedure. The diagnostic procedure is now being rolled out across the NHS in Scotland through the ScotCap programme to support endoscopy service remobilisation and alleviate pressure on the NHS following the Covid-19 pandemic.
Other partners involved in the project include The Maersk Mc-Kinney Moller Institute; Lund University; Umeå University; UiT-The Arctic University of Norway; National & Kapodistrian University of Athens, and Universitat Autònoma de Barcelona.
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