Advice

The technology

The technology

VIDAvision (VIDA Diagnostics) is a suite of imaging analysis software applications that provides quantitative CT (QCT) lung volume analysis from CT datasets. It allows for 3D visualisation of lung anatomy including airways, fissures, parenchyma and a range of CT biomarkers – such as fissure integrity – and analytics. This visualisation can then be used to assess a patient's suitability for therapies.

VIDAvision can be used to do a range of analyses including:

  • airway mapping for bronchoscopy biopsy

  • lung cancer resection precision reports

  • lung density

  • air trapping information in people with chronic obstructive pulmonary disease (COPD) and asthma

  • lung volume analysis to support treatment selection

  • planning for endobronchial lung volume reduction (ELVR) surgery in people with emphysema.

The latter use – planning for ELVR surgery in people with emphysema – is the focus of this briefing.

VIDAvision can be used with a range of high-resolution CT scans; it can also be used with a standard CT lung screening exam if the slice thickness is between 0.5 mm and 1.25 mm. All personally identifying information is removed from the CT scan before it is uploaded to the VIDA platform. The hospital anonymises the scans and applies a unique identifier to them before sending the scans to the company. The unique identifier will be used to match results to the patient file when the scans are returned.

Later, the company sends a report about each patient's scans to the VIDAvision platform at the hospital. From there, clinicians – such as a respiratory physician, interventional radiologist or radiology technician under the supervision of a respiratory physician or radiologist – can view and evaluate the results in the lung volume analysis function of VIDAvision. The report is received within 72 hours but usual turnaround time is about 12 hours.

Innovations

VIDAvision can help health professionals to assess if people with severe emphysema are good candidates for ELVR surgery by using interlobar fissure integrity values. Fissure integrity values are a surrogate for collateral ventilation, which is measured by forced expiratory volume in 1 second (FEV1).

VIDAvision provides QCT assessment of lung function which may be faster and more accurate than the current manual methods.

The VIDAvision test is non-invasive.

Current NHS pathway or current care pathway

People with emphysema for whom ELVR surgery may be appropriate are usually identified in secondary care. To check if this is the case, health professionals run tests with a spirometer to measure FEV1; this aims to assess how well the lungs are working. If more tests are needed to confirm the diagnosis or determine the severity of disease, people may also have any of the following tests:

  • electrocardiogram

  • echocardiogram

  • peak flow test

  • blood oxygen test

  • CT scan

  • phlegm.

Standard clinical assessments of BMI, smoking status, assessment of comorbidities and patient preference on treatment options are also evaluated. The specific sequence of diagnostic tests to select patients for ELVR vary in practice and few patients in the UK receive bronchoscopy to assess whether ELVR surgery is needed.

The following NICE guidance has been identified as being relevant to this care pathway:

Population, setting and intended user

VIDAvision would be used in patients with severe emphysema who are being assessed for lung volume reduction procedures. There is insufficient information to judge whether it would replace, or add to, current diagnostic tests. The technology would be used by respiratory physicians or thoracic surgeons.

Costs

Technology costs

An annual subscription for VIDAvision costs from £18,000 (for up to 50 scans) to £40,000 per year (for up to 200 scans). The average price per scan would be between £200 and £360, depending on the level of use. The cost of using a CT scan including the cost of reporting for 1 area without contrast is £85.69 (RD20A). The total cost of using VIDAvision would be £285.69 to £445.69.

VIDAvision is usually leased on a 1- to 5‑year term. A computer with internet access and a web browser is needed to use the software. VIDAvision is sold as a subscription and includes software, scan analysis maintenance, support, installation and education. VIDAvision can operate with an existing CT scanner.

Costs of standard care

  • CT scan of 1 area without contrast (RD20A) cost £85.69 on the outpatient tariff.

  • Lung volume studies (DZ45Z) cost £132.87 on the outpatient tariff.

  • Plain film x-ray (DAPF) costs £29.78.

Bronchoscopy:

  • £686.15 for diagnostic bronchoscopy conducted as a day case (DZ69A).

  • £875.13 for bronchoscopy including endobronchial ultrasound conducted as a day case (DZ64C).

Resource consequences

Introducing VIDAvision would be an additional cost. Standard assessment methods vary and it is uncertain whether VIDAvision would replace or add to current diagnostic tests. Opportunities for cost savings include improved patient selection for ELVR surgery and savings in clinician time and disposable resources needed to do bronchoscopy, lung volume studies or chest X‑ray. Adopting the device would need CT machines to be set up to use the software. VIDAvision is not currently used in the NHS as part of routine practice.