Impact case study database

In 2019, there were approximately 25,900 commercial aircraft in the world and the majority (54%) were equipped with GE engines.

An extensive experimental project funded by GE Aviation used the Multiple Cavity Test Facility to acquire design information for use in modelling disc life and compressor blade clearances.

The quality of the data obtained from this test facility is superior to that from an engine test for two reasons. Firstly, there is far greater spatial density of instrumentation in the test rig. Secondly, in an engine test it is not possible to decouple some of the important variables (e.g. rotational speed, bore flow, surface temperatures and shaft speed) whereas in the test rig, these can all be controlled independently. Consequently, there is also far greater confidence in the rig data than in previous engine test data [S1, S2 and S3].

To quote Julius Montgomery, Principal Engineer at GE Aviation:

“To date, the multiple cavity test facility has provided extensive high-quality data. The immediate and direct impact is that it has done so without requiring an expensive engine test, which I estimate would cost around £4M. The work to date has also led to reduced uncertainty in our design process, improved modelling methods, confidence and maintenance scheduling. It has also informed a number of design changes in our engines, which may contribute to improvements in both fuel consumption and emissions. For a single engine over its typical life, the savings in fuel and CO₂ emissions that may be possible through this project I estimate to be in the region of 75 tonnes of fuel and 200 tonnes of CO₂.” [S5]

The additional impacts of this work are:

1) The maintenance schedule for an individual engine is predicted using mathematical models tailored to its flight cycle history. Due to uncertainties in the flow physics, this can lead to a costly pre-emptive engine overhaul. For a GE engine, this typically costs around £2M and its timing is usually dictated by the disc replacement schedule. The data from the test rig [S1, S2, S3] was used to improve these models, reduce uncertainty and potentially reduce unnecessary engine overhaul.

2) The test rig provided design information to support flow and thermal modelling of the latest and subsequent generation of GE engines (the replacement for the CFM56, the LEAP with more than 2500 engines in service with an indicative value of £30B; and the replacement for the GE90, the GE9X with over 700 engines on order with an indicative value £30B). The test programme [S1, S2, S3] addressed the effects of geometric changes in the design of the disc bore and central drive shaft on the heat transfer in the disc cavities. This allowed for improved confidence in the modelling, by GE, of not only disc stress and life, but also in the transient behaviour of the radial clearance between the compressor rotor blades and outer casing, significantly affecting performance, fuel consumption and emissions.

3) Due to differential thermal expansion between rotating and stationary components and depending on mounting arrangements, the main rotor can sag during cool down when rotation ceases. If engine power is applied too soon, then undesired contact can occur between these components. This can place limitations on the turnaround time for short-distance shuttle flights, where the time between landing and take-off is relatively short to allow for maximum use of the aircraft. A solution is to rotate the engine, slowly, under the power of an electric motor during this cool down period. However, no data existed to take the concept through to detailed design. Data was acquired from rig testing at Sussex to supply engine designers at GE with this information, and used in the GE LEAP engine.

GE Aviation also funded an experimental test programme on the Turbine Rim Seal Test Facility to acquire data for the modelling of the behaviour of the flows in a high-pressure, turbine stage, representative of their latest designs. This work [S4] has led to additional impacts that benefit GE Aviation from improved disc life, reduced blade clearance and reduced aerodynamic sealing flow without use of an expensive engine test.

To quote Julius Montgomery, Principal Engineer at GE Aviation:

“This [turbine rim seal] work has also saved having to carry out a further engine test, leading to a direct saving of £4M. The indirect impacts (reduced uncertainty, improved modelling confidence and maintenance scheduling) will be similar to that from the multiple cavity test facility. For a single engine over its typical life, the savings in fuel and CO₂ emissions that may be possible through this project I estimate to be in the region of 18 tonnes of fuel and 50 tonnes of CO₂.” [S5]

There are also the benefits of supplying high-quality rig data to improve the design process through improved confidence and reduced uncertainty. It is difficult to quantify these benefits, but Julius Montgomery has suggested that it would take an extra six person-months of effort (£150k) to overcome the problems associated with poor quality engine data [S5].

Enabling Plessey Semiconductors to develop and market innovative sensor devices

A wide range of practical applications have emerged from the research to develop the pioneering sensors described in Section 2. Much of this impact has been generated through a commercial relationship with the company Plessey Semiconductors, which bought exclusive rights to develop, apply, and sell the sensor technology under licence from the

University of Sussex. The relationship led to the first integrated-circuit version of the EP sensor being produced, and this was subsequently marketed as the Electric Potential Integrated Circuit (EPIC). [text removed for publication] of Plessey Semiconductors confirms:

“This initial research and IP, together with continued collaboration, was instrumental in Plessey’s subsequent development of an award-winning range of novel sensor products, the Electric Potential Integrated Circuit (EPIC).” [5.1a].

In addition to enabling this “ significant advance” in Plessey’s capacity for product development, the collaboration has also led to economic benefits:

“The EPIC Business line is estimated to have safeguarded and created of the order of [text removed for publication] jobs at the company. During the period 2013 to 2019, Plessey invested [text removed for publication] in technology development, market analysis and business development, gaining traction in a number of applications and achieving revenue in excess of [text removed for publication] … The EPIC technology… enable[d] us to establish important engagements with a few major strategic companies world-wide across several products and applications, including [text removed for publication]. Some unique processing technology was developed and through a five-year period it permitted Plessey to maintain and establish a wider technology/electronics integration group which continues today in the support of a major partnership with [text removed for publication].” [5.1a].

Through its agreement with Plessey, the University of Sussex has earned more than [text removed for publication] in license fees, royalties and other associated payments from the technology [5.2], and Plessey’s commitment to its development was further indicated by their meeting of consumable and sensor costs, as well as an in-kind contribution of [text removed for publication] in staff time. The patents covering the technology are extensive, including Europe, USA, Japan, Germany and France, demonstrating the significant reach of the IP [5.3].

Many of the terms and details of this agreement with Plessey, including their customers, are commercially sensitive and confidential. But real-world applications based on the research outlined in [3.1-3.3] have generated “ revenues [that] included:

• Car seat demonstrator kits to tier one automotive suppliers and EOMs

• single lead ECG devices into several NHS Trusts, 30 devices comprising a major trial within the [text removed for publication] Health Authority

• *EPIC device sales into several early-stage product developments in the healthcare sector, including [text removed for publication] and numerous start-ups.*” [5.1a].

Devices produced by Plessey using the EPIC sensor technology include a fully certified single lead electrocardiogram (ECG) product called imPulse^TM for use by non-specialists in GP surgeries [5.1b]. With no need for skin preparation, use of conducting gel, or accurate electrode positioning, the imPulse monitor made it easier and quicker for healthcare workers to acquire high-quality clinical data with minimal training. For example, one consultant cardiologist confirmed that: “ Having performed an initial test of imPulse lead-one ECG device, it is clear that this device is able to provide and record a usable single lead ECG similar to lead 1 of a 12-lead ECG” [5.10].

ImPulse was also one of five devices included in an NHS-funded project that delivered 6,000 mobile ECG units to GP surgeries, clinics and pharmacies in 2018 [5.5]. Professor Gary Ford, Stroke Physician and lead on the project for the Academic Health Science Networks (AHSNs), said:

“We have highly effective treatments that can prevent these strokes, but early detection is key. Using cost-effective technology, the NHS will now be able to identify people with irregular heart rhythms quickly and easily. This will save lives… Today’s new devices are just one example of the way that low-cost tech has the potential to make a huge difference.” [5.5].

Individual AHSNs have also worked directly with Plessey, providing support for the regional evaluation and adoption of imPulse. For example, the Deputy Director of Innovation & Growth, West of England AHSN, confirmed:

“Colleagues in primary and secondary care have welcomed imPulse’s potential to improve the patient experience and give reassurance in rapidly capturing quality ECG signals. The interactions between Plessey staff and frontline healthcare practitioners have benefitted all parties as practitioners help to shape novel products that work in real healthcare settings.” [5.10].

An NIHR review commissioned by NICE (National Institute for Health and Care Excellence) on the clinical and cost effectiveness of ECG devices in primary care concluded that the use of seven devices, including imPulse, “ appears to be a cost-effective use of NHS resources” [5.4a]. A subsequent trial conducted by the Exeter Clinical Trials Unit, with 217 participants from one large hospital in Devon, found that “ Atrial fibrillation was diagnosed in 45 out of 215 individuals who had ECG traces and 42 out of 199 individuals who also had an imPulse measure” and that it “ *worked particularly well at higher heart rates (above 80 beats per minute)*”. Additionally, “ the imPulse device demonstrated superior specificity to pulse palpation, with higher positive predictive values, thus suggesting the potential to reduce referral for confirmatory ECGs in non-AF cases, if used instead of pulse palpation.” Since ECGs are “ *expensive, time consuming and usually require a separate appointment,*” the study concluded that “ the imPulse device could therefore be used to screen for atrial fibrillation and reduce the number (and therefore cost) of ECG referrals and time taken to diagnose atrial fibrillation.” [5.4b]

ImPulse’s contributions in the medical technology sector have also been recognised through a number of awards; for example, Plessey (for imPulse) won the National Technology Awards 2017 in the “Healthcare Technology of the Year” category [5.11a], and was shortlisted for the Elektra Awards 2016 in the “Excellence in Product Design for Medical” category [5.11b].

Vital sign monitoring using the sensor technology is also valuable in other sectors, including the motor and airline industries, which face increasing regulatory pressure to detect when drivers and pilots are not alert. Of direct relevance to Plessey was the production of an armband heartrate device with woven flexible electrodes. This formed part of a project with Nottingham Trent University [5.9] and contributed to the development of the WARDEN^TM – a novel seatback device featuring a driver alertness monitor, which assesses heartrate and breathing. The technology was showcased and discussed at industry events including the Paris Motor Show in 2016 [5.7] and Geneva Motor 2017.

In 2019, the US company [text removed for publication] bought the sensor products and relevant IPR from Plessey for an undisclosed amount. [text removed for publication] intends to develop the technology for a broader market and this will extend the impact of the research further. [text removed for publication] is currently negotiating its licencing agreement with the University of Sussex. [text removed for publication] is well placed as a US-based medical instrument company to access the vital US markets and has a proven record of obtaining US venture capital funding.

Expanding the applications and beneficiaries of Sussex EPS technology

In 2019, the Sensor Technology Research Centre was approached by [text removed for publication], who subsequently invested in work to produce a non-contact fingerprint scanner for use in [text removed for publication]. A key advantage of the EPS technology in this application is that it is completely non-invasive and so does not preclude the use of other analysis techniques after a fingerprint has been imaged. In addition, EPS makes it possible to estimate the time elapsed since the fingerprint was deposited, which conventional techniques cannot achieve. [Text removed for publication] [5.8].

Further collaborations have arisen for the sensors’ application in the medical sector, beyond those described above. The EPS technology is now being used by the charity Rockinghorse, with the Trevor Mann Baby Unit at Brighton and Sussex University Hospitals Trust, to develop a novel sensory heart rate monitor that midwives and neonatal staff can use with new-born babies. The charity anticipates that the ‘Neo-sense’ device will “ provide a non-invasive, reliable and quick-to-administer solution to measure the heart rate of a baby… during [their] first minute of life.” Ethical approval and funding are under preparation for a pilot study of the technology planned for later this year [5.6].

The research described in section 2 led to an initial patent (filed in 2007, patent GB0705223.6 [S1].) Further improvements in algorithms and software performance over the next four years then allowed the research team to launch a commercial product TexRAD. This is an advanced image texture analysis software tool that analyses routinely acquired diagnostic medical images (for example CT and MRI scans) to reveal features not always evident to the human eye. The software also includes a novel data-mining tool to statistically analyse results and identify parameters associated with patient outcome.

Following further commercial development supported by the Regional Development Agency and the University’s Enterprise Development Fund, a spin-out company, TexRAD Ltd, was launched in 2011 as a joint venture between the University of Sussex, Imaging Equipment Ltd, Cambridge Computed Imaging Ltd, and Miles Medical. The Scientific Director and subsequently CEO of TexRAD since its foundation is Dr Balaji Ganeshan, who had been supported by the University’s Enterprise Development Fund; and the clinical founding director is Prof Kenneth A. Miles (who was employed by Brighton and Sussex Medical School until 2011).

In 2014, TexRAD merged with Feedback plc. Sales of the TexRAD software has increased the income for Feedback plc (which currently has a market value of £11.74 million (18/11/2020 LSE)), and CE approval, granted in 2017 [S2], led to a lucrative licensing and distribution agreement with General Electrical Healthcare (GEHC) [S3]. Feedback plc’s 2020 annual report (for year end May 2020) confirms that: “to date, TexRAD has been deployed in more than 60 research centres around the world, each one looking to find a link between texture changes and disease.” [S4a]

The software has been licensed to numerous hospitals in the UK, North America, Europe, Asia and Australasia, where it is used to produce information critical for clinical trials and medical studies. Eight hospitals in the UK use TexRAD, including King’s College Hospital, University College London Hospital and the Cambridge University Hospitals. Internationally, users include:

• North America: Johns Hopkins University Medical School, Georgetown University Hospital, University of Mississippi Medical Centre, Massachusetts General Hospital, Scottsdale Clinical Research Institute, University of Wisconsin, University of Pittsburgh School of Medicine [S4b], Indiana University, St Jude Childrens’s Research Hospital, Sunnybrook Health Sciences Center (McGill University) Canada.

• Europe: Aarhus University Hospital, European Institute of Oncology, Oslo University Hospitals, University of Rome Sapienza, Universitatsspital Basel, Centre Hospitalier Universitaire de Reims, Evangelische Lungen Klinik, Haukeland University Hospital, Gustave Roussy Cancer Centre, University, Centre Hospitalier Universitaire De Grenoble, University of Brescia [S4c], Turku University Hospital.

• Rest of world: Tata Medical Centre, India; Peking Union Medical College Hospital, China; International University of Health and Welfare, Japan [S4d]; Seoul National University Bundang Hospital, Korea; Princess Alexandra Hospital, Australia.

For example, in 2018 researchers at the Princess Alexandra Hospital (Australia) published an 18-month prospective observational study in Academic Radiology, for which it provided the TexRAD software to five radiology and nuclear medicine specialists as a tool to quantify texture parameters in lung tumours. Among other results, the study observed “significant differences in survival… for patients categorized using the two reported CTTA values” [S4e]. Feedback plc announced that these findings “ suggest that there is a huge potential for the implementation of quantitative imaging in the assessment of tumour heterogeneity and engagement from radiologists is key to its success.” [S4e]

One client, Andrea Laghi, Professor of Radiology at the Sapienza University of Rome, says: “ TexRAD deeply helps my research team in exploiting medical images in oncologic patients.” He adds: “Data mining is critical in current oncologic research. It is complex and takes time. TexRAD is a user-friendly platform which makes our data analysis semi-automatic and thus easier and quicker than other manual approaches.” [S4f]

Another customer is Imaging Endpoints, a major US clinical imaging company that employs 40 radiologists. Ronald L Korn, the company’s CEO, said:

"TexRAD is a very powerful software analytical tool that allows for in-depth evaluation of solid tumours for predictive, prognostic and treatment response categorization. We have used it in our Core Imaging lab on multiple occasions to help accelerate drug development for our pharmaceutical clients. It truly offers advanced information unlike any other technology in the field!" [S4g]

In January 2020, Imaging Endpoints announced it had been issued a patent for a “ breakthrough radiomic evaluation tool [that] allows for rapid diagnosis of the nature of a patient’s breast abnormalities from standard mammography images”, enabled by TexRAD technology. Commenting on this technology – which the company anticipates “ could provide patients and physicians the advantage of faster, less invasive information that is critical to treatment decisions and patient outcomes” – Korn states:

“A reliable imaging signature for differentiating between malignant and non-malignant BI-RADS 4 mammographic lesions has remained elusive until now. The Imaging Endpoints invention provides a biomarker signature for determining whether a lesion identified in a breast image is malignant. The signature is derived from processing mammography data using a Quantitative Textural Analysis™ platform (TexRAD); generating respective histograms and related quantitative metrics, and performing logistical regression to yield a model predictive signature. Imaging Endpoints believes that its technology offers a real-time advantage with rapid results.” [S4h]

New orders for TexRAD have also been received from France, Italy, Belgium, and Portugal, expanding the customer base in Europe [S5]. Feedback have also signed an exclusive marketing and distribution agreement with Korea Computer Motion ISG [S6a], who have access to a large number of medical imaging customers. Samsung Medical Centre purchased TexRAD in September 2018 [S6b,c], as a part of the new PET-CT scanner installed by Siemens at Seoul National University Bundang Hospital (SNUBH) for use by the Nuclear Medicine department. Research, facilitated by TexRAD, will be conducted there on cancer and other diseases, to inform clinical decision-making in the diagnosis and management of patients.

Dr. Ho-Young Lee, Assistant Professor in the Department of Nuclear Medicine, Seoul National University, comments:

"We are very excited with the prospects of using the TexRAD imaging research software platform in conjunction with the new PET-CT scanner being installed at our institution, further reinforcing our vision and reputation of being early adopters of new technologies, particularly in the fascinating area of quantitative imaging and its applications in cancer care" [S6c].

TexRAD has also had significant impact in the treatment of kidney stones. Licensed as StoneChecker, the software helps to distinguish those patients who would respond best to lithotripsy — treatment which breaks up kidney stones using sound waves — from those for whom surgery might be more appropriate. Lithotripsy is less invasive and, for kidney stones smaller than 20mm, it is cheaper than surgery (including minimally invasive options such as percutaneous nephrolitholapaxy) [S7a]. Nevertheless, each treatment costs around £1,200 in the UK [S7a] and over $13,000 in the USA. Further, lithrotripsy fails and surgery is required for around a third of patients. The technology therefore supports a key decision about treatment. In addition, the technology supports clinical decision-making by helping to estimate the number of sound-wave shocks that will be needed for successful treatment.

Markets in Europe, the USA and Korea were opened by the granting of regulatory approval to StoneChecker software in 2017 (CE approval **[S8a]**), 2019 (FDA approval **[S8b,c]**) and 2020 (KFDA approval **[S9a,b]**) respectively.

In 2019, the UK National Institute for Health and Care Excellence (NICE) published a briefing on StoneChecker that concluded : “CT texture analysis using StoneChecker can differentiate uric acid from non-uric stones… This may make it possible to predict the number of shocks needed to treat kidney stones.” It also recorded experts’ comments that StoneChecker “could help clinical decision making about treatment choice”, especially for patients at high risk of lithotripsy failure, or those with no symptoms but with large or multiple stones.” [S7b]. This briefing is highlighted in the flowchart designed by NICE to support those in the NHS considering using or commissioning new technologies for the treatment of Renal and Ureteric Stones [S7c], embedding the reach of StoneChecker across all hospitals in England.

StoneChecker software has already guided the treatment of more than 1,000 patients in the USA, European Union, China and South Korea [S10]. Kidney stones affect around 300,000 million adults around the world, and the substantial investment in the technology by hospitals globally indicates that many thousands of patients will benefit in the near future.