Scotland at forefront of ‘gamechanger’ €6m project to improve bowel cancer diagnosis

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.

Clinical Capsule Endoscopy (CCE) utilises a ‘smart pill’ containing cameras which, once swallowed by a patient, records images of the intestines as it passes through.

The diagnostic procedure is currently 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.

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.

Now a consortium of 12 partners across Europe, has received a £6 million 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.

The 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 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 game-changing 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, and has fantastic potential to reduce the capacity pressures NHS health boards across the UK are experiencing.”

Professor George Crooks OBE, Chief Executive Officer, Digital Health & Care Innovation Centre, said: “Harnessing innovative technology to support the day-to-day management of patients is becoming increasingly recognised as one way that the NHS can deal with the significant challenges that it faces today. 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 underway 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: “The CCE service in Scotland started in the Highlands. NHS Highland was the first health board in Scotland to trial the procedure. As a result of this work the test is now available throughout Scotland.

“There are many advantages to CCE but the addition of AI will be a game changer. 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.”

The 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.