Into the LIONS’ DEN

Forging the future of medicine for New Brunswick

Seven years ago, Zach Kilburn was at a conference in Chicago when he first heard of how other hospitals were using 3D printing. He was immediately intrigued by its potential for his field of medical imaging.

Medical images like CAT or PET scans and MRIs are presented on a screen in two dimensions. Surgeons, who work on their patients in a three-dimensional world, must make leaps of inference between the images and the clinical reality.

Introducing a 3D printer would bridge that gap, allowing surgeons to print a replica of their patient’s unique anatomy in three dimensions, from blood vessels and bones to other body tissues. Surgeons could plan and practise before the procedure, studying the precise clinical indications and structures on which they'd operate.

“There were a few 3D printing programs going on at the time, and they really showed how it matched with diagnostic imaging – how those images could be pulled out of CAT scans and MRIs and brought to life with 3D-printed objects,” - Mr. Kilburn, Regional Director of Diagnostic Imaging at Horizon Health Network, recalls now.

He wanted to bring the idea back home to New Brunswick and avidly started talking to vendors and developing a proposal.

Then, three years ago, plastic surgeon Ian Maxwell and radiologist Darren Ferguson came into his office. Dr. Maxwell, who had arrived at the Saint John Regional Hospital after having used 3D printers in other provinces, wanted to make a model of a patient’s skull to prepare for an upcoming surgery.

“That's great,” Mr. Kilburn told the doctors. “But we do not have that technology as it sits right now.” However, he told them of the proposal he was working on and asked if they’d like to join in. They jumped aboard. The idea would be groundbreaking for New Brunswick.

The Regional would become the first hospital in the province to acquire a 3D printer. It would lay the groundwork for even more advanced, tech-enabled medical imaging and 3D printing opportunities to further drive better patient outcomes, open the door to new levels of collaboration between the clinicians and technicians within and beyond the province, and provide the chance to develop intellectual property and help recruit top talent to the hospital.

They just needed to find the right opportunity to pitch their idea and get the funding to make their concept a reality.

Then Lions’ Den came along. The medical competition with a $500,000 prize and a focus on innovation in health care seemed perfect.

When corporate director and philanthropist Miranda Hubbs puts her money and time into something, she wants to see the impact.

“You can write a cheque,” she says, “but that's no fun. You want to know where it's going.” So when she was asked to join the judges’ panel of Lions’ Den, the Saint John Regional Hospital Foundation’s flagship competition for innovation in health care, it was an easy yes.

In 2018, the Foundation was the first in Canada to host a Dragons' Den-style pitch competition, inspiring similar events hosted by other hospital foundations in Toronto and elsewhere. The 2021 iteration’s reality show format further advanced its innovative approach to health care fundraising.

A corporate director and philanthropist, Ms. Hubbs was one of a panel of five judges – the Lions – who each gave $100,000 and their astute acumen to the cause. While Ms. Hubbs lives in Toronto and doesn’t have any direct links to New Brunswick, Lions’ Den “wasn't a tough sell,” she says.

Ms. Hubbs was introduced to the Lions’ Den concept through Derek Pannell, a Saint John businessman with whom she has served on a couple of corporate boards.

A couple of years ago, when the Saint John Regional Hospital Foundation was looking for judges for its next instalment, it was an easy yes.

“It is such a great cause, and the people involved are so passionate,” says Ms. Hubbs, Vice-Chair of the Canadian Red Cross and co-founder of Tiffany Circle, a group of women philanthropists in the Red Cross. “And when I heard what a difference this program had made, what they were able to fund and get into the hospital from a technology and programming point of view, I was in.”

In the spring, she and her fellow judges met over Zoom to choose the winning pitch after reviewing briefs on the three competing projects. Ms. Hubbs and Scott McCain, Chair of the Board of McCain Foods Ltd., were in Toronto; Mike Webb, Executive Vice-President of Nutrien, dialled in from Calgary; Dr. David Elias, CEO of Canadian Health Solutions, and Bob Owens, Co-founder of Owens MacFadyen Group, were in Saint John.

For Dr. Elias and Mr. McCain, this was a return performance. Both were judges in the Foundation’s original production in 2018.

Mr. McCain, who is CEO of the Saint John Sea Dogs and has strong family and business roots in New Brunswick, says that besides being a “cool concept” for a fundraiser, the local connection clinched his involvement.

“There's no shortage of organizations looking for support,” he says. “What attracted me to this was Saint John, first and foremost. And the Saint John Regional is the largest, most highly respected hospital in the region.”

And as a sports fan, he loves a little friendly rivalry.

“When you have a competition, it's more fun,” he says. “And competition drives better performance. When you're up against your colleagues to compete for limited funding, you're going to put your best foot forward.”

While Ms. Hubbs says each Lion came into the deliberations with different ideas of what they wanted to fund, they found their way to unanimity. She and Mr. McCain both credit Dr. Elias, a physician, for helping them understand the medical implications of the proposals before them.

First, they heard from Team Improving Speed & Accuracy of Drug Detection. This team sought to buy a Tandem Mass Spectrometer to increase the number of drugs the Regional’s lab can identify in a single sample, cutting the time from test to results to improve patient safety and prevent overdoses.

Next up was Team Imaging Enhancement Centre – Mr. Kilburn, Dr. Ferguson and Dr. Maxwell – with their pitch for a 3D printer that would give clinicians a virtual copy of their patient’s anatomy to plan and practise surgery, improving patient outcomes and increasing efficiency.

Finally, they heard the Team Enhanced Lung Cancer Care proposal for leading-edge diagnostic equipment for earlier detection. That team also proposed creating a navigator position to better support lung cancer patients through a scary and overwhelming process.

“The pitches were educational, they were inspiring, and what they’re proposing all change and save lives,” Ms. Hubbs recalls. “Everything that they showed us was a better path to a better future for people. Each one of those projects fulfilled that promise.”

While the Lions deliberated in three locations, the cameras of film crews in three provinces rolled. Like so many projects initially slated for 2020, Lions’ Den had to adapt.

The competition was originally going to follow the same format as its first iteration in 2018: a live event in front of a packed house at the Imperial in Saint John. But when COVID-19 made that kind of gathering risky, if not outrightly prohibited, the Foundation shifted from stage to screen.

“The production challenges of having three film crews working simultaneously across the country were significant,” says Shannon Hunter, the Foundation’s Director of Marketing and Communications. “Thanks to our crews, our Lions and our medical teams, who showed such creativity and flexibility, we made it work.”

Working with Hemmings House, a Saint John film production company, the Foundation switched gears to create a reality TV-inspired documentary.

“The show must go on,” Scott McCain says. “And they made it very painless and easy.”The production kicked off early in 2021 when each of the three medical teams was paired with a local marketing professional to help them craft an original video pitch. Through the winter, they worked on their three-minute videos, which became the centrepiece of the final, 30-minute documentary capturing the entire journey, from concept to winning pitch. (If you missed it, the full film can be found on the Foundation’s website.)

The production challenges were significant. The hospital was off-limits, so shooting footage of the teams in their professional settings was out. Along with masked crews and socially distanced film sets, some shoots had to be rescheduled around pandemic lockdowns and restrictions. Filming the Lions’ deliberation day had to wait until Alberta, Ontario and New Brunswick’s rules allowed it.

“I was so impressed at the way the Foundation was able to pivot and make the most of it,” Miranda Hubbs says.“And, as it turns out, I think they'll be able to leverage this a lot further than a one-night event.”

While the original event in 2018 was seen by some 500 people in the theatre audience, the viewing potential of the new one was unlimited, unbound by time and space constraints. By September, more than 128,000 people had viewed the trailer online and in cinemas across New Brunswick.

Since the launch date, the website has had more than 16,000 views, and the film has been watched online more than 2,500 times. And when it aired across Atlantic Canada on CTV on Sept. 18, the potential audience was more than 356,000.

The Lions weren’t the only ones who got a vote. On Sept. 10, when the show aired online and the winner was revealed, the public was invited to select the winner of the Community Choice Award. This $75,000 prize, provided by J.D. Irving, Ltd., was “unlocked” by Team Enhanced Lung Cancer Care when it hit matching community donations.

Ultimately, Team Imaging Enhancement Centre emerged victorious, nabbing the $500,000 grand prize as well as a $100,000 research grant from the New Brunswick Innovation Foundation.

The biggest factor in the Lions’ decision?

“Whatever we funded had to go beyond the hospital’s immediate needs and was able to be set up and leveraged for the future as well,” Ms. Hubbs says. “The Imaging Enhancement Centre takes the Saint John Regional Hospital to the leading edge of technology, and then they can leverage that to make it go even further.”

The judges also considered how the winning proposal would better position the hospital to recruit and retain top talent to help improve the standard of care. “What you want is that one thing no one else has. So for
anyone who wants to train and learn and go into that area of expertise, this is the place to be. The Imaging Enhancement Centre can become that place to be,” Ms. Hubbs says.

The New Brunswick Innovation Foundation can help make connections to potential partners and other funders to push the technology to its full potential.

“What can you do with that tool that's going to be new and innovative and open up new avenues of health care in New Brunswick?” says Laura Richard, the Innovation Foundation’s Director of Research. “Beyond the immediate applications, there's a lot of other directions you can go with that equipment and expertise. What else could we explore that's cutting edge?”

Dr. Richard sees the potential for the Imaging Enhancement Centre to generate new intellectual property that is both exportable and a magnet for recruitment. “What they are doing has a really broad scope of possible applications because it's bringing engineering methodologies into the medical space,” she says. “When you make those kinds of cross-disciplinary jumps, there's a lot of directions you can go.”

By the spring of 2022, the new Imaging Enhancement Centre at the Saint John Regional Hospital hopes to 3D print its first model.

There’s much work to be done in the meantime. Since their Lions’ Den win, Mr. Kilburn and his team have kicked into action. They need to staff the centre, drawing on technologists from their current team, whose 3D post-processing skills will translate nicely to 3D printing.

And then there’s the space itself. They are working with the facilities team on renovations, including installing big windows to showcase the printers and other technology to patients and the public. Mr. Kilburn says anyone on their way to a CAT scan or MRI – some 40,000 people a year –will pass by.

“It’s a great way for them to see what New Brunswick is doing when it comes to medical innovation, how we're pushing things forward,” he says.

He is also in conversation with a number of stakeholders, including other hospitals in New Brunswick, that will be able to access the technology. A physician from Bathurst, say, or Moncton, will be able to send images to the centre, where they will be 3D printed and shipped back.

And while his team’s Lions’ Den pitch focused on the pre-surgical benefits of 3D printing, there are many other possibilities. The models can be used in patient education and involvement, helping physicians better explain a condition or procedure than two-dimensional medical scans allow.

“It’s really hard for people that aren’t used to looking at images in slices or at cross-sectional anatomy to visualize what’s happening in their body,” Mr. Kilburn says. “The printed models can go a long way in promoting better outcomes because the patient understands what they're working with.”

Along with anatomical models, 3D printers can create tools, prostheses and even repair parts for medical devices that aren’t possible or are extremely challenging using traditional methods.

“There are hundreds if not thousands of different applications, both within health care and outside of it,” Mr. Kilburn says. “We're only scratching the surface.” Even beyond the hospital and the Horizon Health Network, opportunities for collaboration abound.

“There are some really exciting partnerships we could explore,” Mr. Kilburn says. Following the win, he’s been contacted by educational institutions such as the New Brunswick Community College and the University of New Brunswick in Saint John, economic development agencies such as Opportunities New Brunswick and even the private sector.

“It's really exciting to explore those things that are outside of health care,” he says. “Our main goal is patient-care delivery and improving those patient outcomes. But all of those things come hand-in-hand with developing the program and growing it further.”

Beyond 3D printers, the Imaging Enhancement Centre encompasses other technologies, including artificial intelligence. Mr. Kilburn’s department is the first in Canada to invest in SubtlePET, AI-powered software that uses a sophisticated algorithm to increase the efficiency of its scanners. Along with reducing the costs of the wildly expensive isotopes those scans use and the amount of radiation a patient receives, it can lower wait times and increase patient throughput by about 30 percent.

“We're going to find things like this that are game-changing,” he says. There are also clinical engineering applications to explore, such as 3D printing prosthetics and tools, models for medical education and repair parts for medical devices.

“There's untapped potential all over the place,” Mr. Kilburn says. “If your brain can dream it up, it could be possible, it could be printed.”

In case you missed it, WATCH our 2021 Lions’ Den Medical Competition: