David Busch is an Assistant Professor at the University of Texas Southwestern Medical Center. Prof. Busch was a PhD researcher at the University of Pennsylvania, where he met and shared labs with Prof. Turgut Durduran. Years later, in December 2015, he went to ICFO for half a year to continue working with Turgut as a visiting scientist and has been visiting the institution every 2 years since.

How did you become involved with VASCOVID?

David Busch. Turgut and I overlapped as PhD students and then when he was a postdoc and a research scientist, we were both at the same university, the same lab really. So, we’ve known each other for quite a while now.

 What are you currently working on?

D.B. We have another project here in the US, similar to VASCOVID, focused on a device that is less expensive but still delivers key functionality. It is essentially the same technology, although the VASCOVID version uses the most sophisticated version of the technology. Another NIH study we have is on children who are on extracorporeal membrane oxygenation or extracorporeal life support, ECMO. 30% of the kids aren’t successfully weaned from ECMO and half of the ones who do, end up with brain injury. The point of this study is to determine if diffuse optical tools can identify points of vulnerability, for example in time, potentially leading to interventions to reduce this tragic level of mortality and morbidity. In addition, with Prof. Thomas Floyd, I’m working on minimally invasive optical tools to monitor the spinal cord and brain.

Do you actually see the potential in this type of technique and technology for clinical use? Do you think clinicians will get used to it?

D.B. Well, let’s take for a moment the pulse oximeters, which are really a similar technology. They’re widely adopted and ubiquitous now. You wouldn’t perform anesthesia without one. Now, there are also cerebral oximeters, and that’s an even closer technology. Each has problems, some of which were revealed during the COVID pandemic. The more sophisticated technologies of, for example, Vascovid, get around some problems but may have others. To answer your original question, yes, I do see technologies like this are readily adopted when the cost/benefit and risk/benefit ratios are favourable.

 

How long do you think it will take for the technology to be ready for clinical use?

D.B. VASCOVID has a great advantage due to the fact that ICFO has various technologies already moving on towards inexpensive optical blood flow monitors. Then we have PioNirs, who is already selling a device, which I couldn’t replicate at anywhere near their ­­price, just for components. That’s a big advantage. If you are asking whether I think that, in two years, VASCOVID will receive regulatory approval for clinical use? Well, I don’t know the European regulatory system, but 24 months is not a lot of time for that level of development. The device also needs to be scaled for manufacturability. Do I think that it could be ready to undergo the testing that would put them in the position to do that? That is definitely possible.

Which would you say, are the added values of near-infrared spectroscopy?

D.B. There are two critical things. Or three, really. First, you don’t have to move the patient; second, you can make measurements very frequently, and, finally, the devices are relatively inexpensive. For example, kids in my studies would ideally be getting an MRI every few hours. Setting aside the cost of the MRI and reading the scans, the problem is that an MRI takes an hour and you’ve got to move the children. And also, many of the instruments keeping these kids alive are not MRI-compatible, which means the MRI is contraindicated. Instead, you get an X-ray CT, which is not as good for this purpose and still requires transport. It still takes ~2 dozen people, an hour and you’ve got a radiation dose, so you don’t do it very frequently. Near-infrared spectroscopy is a potentially useful tool for those intermediate periods, providing continuous bedside measurements- such continuous measurements allow the potential for timely intervention.