 From around the globe, it's theCUBE with digital coverage of AWS Public Sector Partner Awards. Brought to you by Amazon Web Services. Hello and welcome to this special CUBE program. We are here with the Amazon Web Services Public Sector Partner Awards Program. It's a celebration of AWS's public sectors, partners and their end user customers where there's been innovation and we're pleased to have on the show here the award winner for the most innovative AI and ML, artificial intelligence and machine learning solution, Axial 3D is the AWS partner and the end user is Belfast Hospital. We've got Roger Johnson, the CEO of Axial 3D and Dr. Tim Brown, consultant transplant surgeon at Belfast Hospital who has been doing amazing things not only as an innovative partner but really during COVID making things happen by solving the problem of the surgical gap and the number of surgeries that you're doing, really high performance, saving lives, congratulations. First of all, congratulations, Roger and Dr. Tim Brown, thanks for joining me. We're pleasure. Okay, let's get into it. First of all, Dr. Tim Brown, I really want to commend you on the amazing work that you're doing before we get into some of the partnership awards, conversations. You have been at the frontline solving a lot of problems around the gap between the number of surgeries that could take place with COVID. Tell that story real quick. I really think it's super important. Take a minute to explain it. Yeah, thanks for the opportunity. It's been an incredible roller coaster for the last three months. Pretty much all of the transplant programs across the world who have been affected by COVID have shut down but with some pretty innovative and real leadership and team working advances we've managed to open our program up again and Belfast we have about 50 disease donor transplants a year. Over the last three months we've just done 90 kidney transplants and pretty much we've cleared the whole wedding list in Northern Ireland pretty much for people waiting for kidney transplant in this time. It's been a remarkable few weeks but really is a testament to the critical care community, the people that work in intensive care as to how much they support urban donation and of course our donors who have given so selflessly at such a tragic time for them. So I'd like to pay tribute to all of our donors and to the amazing amount of people who have been involved in the teamwork at Belfast at this time. That's super amazing. Can you just, I just want to pause for a minute and just capture the number of order of magnitude. You said it was six to 10 for the year and you did nine zero, 90? Yeah, so we've basically done, we've done two years work in six weeks all in the middle of the night as well. So it's been hard work. So you can see the sleeplessness. I'm trying to catch up at the minute but it's been really, really satisfying and an incredible outcome for our patients. The legacy of this program is going to last in Belfast for 40 years. Well, I want to say congratulations. I want to give you my CUBE award for not changing the world but saving the world one person at a time. 90 interviews in six weeks. That's amazing. That's life-changing, clearing the waiting list. You're really changing lives there. Congratulations. That's very kind of you. Thank you very much. Roger, what a great partner and customer you have here. Talk about this award that you guys have. Talk about the company. What is this all about? Why are you guys in this position? Why are you winning? Yeah, so I think our motivation for our company is driven by our partners such as Tim. What they're doing transforms care and even in these horrific scenarios we have at the moment with COVID. I think you're hearing the start of an amazing story. Our job is to give surgeons like Tim the best possible insight that he can have going into his surgeries. For the last 20 years, surgeons have relied largely on 2D imaging, so CT and MRI scans for being able to plan their surgeries when in fact modern technology should allow them much greater insight before they actually perform their surgery. So we've created a technology that platforms on AWS that allows us to turn those traditional, hard to understand 2D images into micro millimeter precise models of the patient's exact anatomy. The value hopefully to amazing colleagues like Tim is that instead of trying to interpret what a 2D image CT or MRI scan might mean, he can actually see for the first time before he opens the patient out exactly what he's gonna find when he starts the surgery. So he can actually start and complete that planning before the surgery actually takes place. So hopefully that allows a number of benefits to result whether that be shorter operations time, less surgical equipment needed to be brought into the surgery, hopefully faster surgeries means less risk of infection for patients, means shorter bed time, means better outcomes for the healthcare system and most importantly the patient. Awesome. Dr. Brennan, I want to get your take on this. Can you describe the impact on your side because the future of work, which is everyone's been talking about in the tech industry for many years. Now with COVID, we were just talking about the successes you're having and changing lives and saving lives. The notion of work, workplace, work forces, work loads, work flows are all changing. Certainly the workplace, people aren't as on site as they used to be. The workforce has to be protected. How does the AI and how does the Axial 3D help you and your workflows? Are you getting more done? Can you give specifics around the impact to your job? Yeah, it's been a fantastic journey to date and we're still learning our way. It's a journey and we're trying to work out exactly where this lies and the fact that COVID has not come along which has changed our working practices, means that we have to look for different solutions. This I think is a very handy solution. So where it's come into my practice over the last three years has been in terms of complex renal surgery and oncological surgery where we have, for example, a tumour in a kidney where we think, my goodness, we're gonna have to take this kidney out and throw it in the bin because it's very badly diseased. So the index case that we were involved with was involving a chap who wanted to donate his kidney to his daughter, but when we worked him up, we find a tumour in his kidney which ordinarily would have to be discarded. But thanks to the imaging that Axial was able to produce for us, we were able to plan well, choose well, cut well and as a result, we took the kidney out, we were able to plan a removal of the tumour from the kidney itself, we were able to repair the kidney and then transplant it into his daughter. So with the technology that was available, we were able to save two lives in one particular case and it's really grown from there where we've now been involved in five or six different real complex cases where the imaging has changed the outcomes for our patients who ordinarily wouldn't have been able to achieve those outcomes. I think the AI interface and the AI solution that we've developed in our partnership with Axial, as I said, it's a journey and we're still finding our way, but the two insights that I've really got are, the first is that what we want to do is reduce variability, not just in our observers from the way that we interpret imaging. Traditionally, as Roger said, we look at 2D images, we're now able to sit and look at this imaging in a three-dimensional space at our desk rather than trying to reconstruct these things in our head. We can then look at them and discuss the different images with our colleagues in real time. And as well as that, which I think is probably the most important thing is that we're now able to engage our patients in a partnership before we've had a bit of an unfair advantage that we're able to interpret these images because we've been 20 or 30 years of getting used to doing this as professionals, but the patients are presented with some incredibly difficult decisions to make about their own health and with very little understanding, but now I can hand them a model of their own disease, they're able to understand, and that gives my patients the autonomy to make the decisions about their own bodies. Back again, I think that's a hugely powerful tool for these guys to have about potential decisions that they'll have to make that will affect them for the rest of their lives. So the problems you were solving was one, the technical problem, so you were trying to figure out manually, you get more insight into the imaging, and two, the customer or the patient, in this case, customer or the patient, can make a better decision. Those are two problem statements that seem to be the big ones. Did I miss anything? Absolutely, no, you got it in one, yeah, absolutely. Okay, so Axial 3D, you guys have a great solution. How did you get here? Tell us about your story. What's the big trajectory for you guys in terms of those value purposes? This seems to be amazing, and again, highlights the advantages of how technology really solves a problem, but the outcome on the patient side is pretty phenomenal. Yeah, so the challenge for us is, or the development that we have made, the leap we have made, is to be able to automatically turn these 2D images into a 3D model. So we take each of the slashes of an MRI or CT scan, using AWS's machine learning. We construct 3D micromilometer precise representation of that anatomy. That's only possible. First of all, we train the algorithms that we created on the Amazon platform, using over a million pre-labeled CT scans. So our system automatically detects at a pixel level, what is bone, what is ligament, what is an artery or a blood vessel. And with the training that we're able to perform, we've been able to, with these million images, we've been able to, in effect, train our system to automatically detect the different parts of the anatomy through this micro-precise level. It hasn't been previously possible. This technology, or the ability to create 3D models, has existed for maybe 10 or 15 years, but it's needed experts like Tim to, in effect, manually code the 2D image at a pixel level and codify it. So some software could turn that into a 3D image. That typically took either 10 hours of an expert like Tim to do. And the problem is Tim could only do one at a time. We estimate there are about 3 million of these complex surgeries each year in the world that need or could benefit from, greatly from this enhanced imaging. And we couldn't get 3 million mandates of experts like Tim to do that. So we had to automate this process. Now on the AWS platform, we could do thousands of these models in parallel. And each model will take maybe a few minutes to turn from the CT into the 3D representation. So through the power of the Amazon public cloud, we've been able to provide this, this powerful machine learning automated solution that can actually scale to the demand that we hope to see in the world. Dr. Brown, talk about the impact, because I mean, Andy Jassy, the CEO of AWS always talks about this when I interview him. He says, we're here to help do the heavy lifting. This sounds like some pretty heavy lifting. What was just talked about, I mean, the manual work involved, you have essentially have collective intelligence and supercomputer power with AWS. What's your take on this as this evolves? Why isn't everyone doing this? Yeah, well, I don't know why everyone isn't doing it. That's the key question, it really is. From my perspective, there is no heavy lifting at all. What I do is I push a couple of buttons, I input a bit of data and I send it off. And from my perspective, it is about as easy as it gets. It's probably as easy as sending an email which we do hundreds of times a day. So from my perspective, I'm delighted to say that there is no heavy lifting at all. I get a patient's data, I send the data through to Excel who will then phone me and say, listen, Tim, what is it exactly that you want? There's a very personal service from Excel. And a couple of days later, there's a delivery of a beautiful life-size 3D representation model, which I can then take to plan. And treat a patient with. So the heavy lifting really has all been done. As Roger alluded to in the past, it was hugely time-consuming work that required a huge amount of training. But now, basically, that's been replaced with a push of the button. And these supercomputers have taken all of my heavy lifting away. And I think this is one of the true representations of how technology really, really advances real-world solutions. And my patients are the benefactors from this. Roger, Dr. Brown, lay out the architecture. Because first of all, pretend I want to take this to every single friend that I have here in California and around the world. I want to just deploy this. What's the architecture? And what's needed on the deployment side? Say it to Belfast as you deploy this. What's kind of involved? Can you just take us through high level? I'm actually cloud-scaled is amazing, no doubt about it. We just talked about that. But what's involved in the architecture side? Am I standing up a bunch of EC2s? Is there SageMaker involved? I mean, what's the architecture? And then deployment, what does that look like? Sure, so taking a slight step back, one of the challenges when we as the MedTech community try and introduce innovation into healthcare and to hospitals, the hospitals IT infrastructure network, I definition is often pretty locked down. So if we're trying to bring new software and load it and install it into the hospital data system, that is a huge often lengthy process that has to jump through lots of hoops in terms of IT, network, compliance, lots of different steps along the journey. And that often wants for very good reasons is a significant barrier to the timely adoption of innovative technologies like ours. What platforming Axial 3D on AWS allows? We're just another website. As Dr. Tim has said, his only existence with Axial 3D in terms of interface is dragging and dropping the CT scan into our website, into our portal. That portal exists totally on the AWS instance in whatever region we are working. The data, for example, in the US never leaves the US. We use the public cloud version in US East. We take advantage of many features within AWS, but a SageMaker is probably a core of what we do. It's that innovation that AWS introduced now several years ago, that has allowed us to produce this machine learning trained set of algorithms that allows us to give this disruption. And it sounds like the more you use it, the more it gets smarter. Is that as well? Absolutely. So our journey is, as Tim said, we're in a journey not only in terms of the technology and you're very perceptive in terms of, yes, the more we train it, the more we train it on specific anatomy types or pathology types or trauma types, the better our system gets at recognizing the specific characteristics of those. But more importantly, this is about the journey, how having made this disruption, we make the change and transformation of new standards of care, of care pathways. That's the innovation that we just enable. It's amazing surgical teams like Tim's that make that transformation. Dr. Brown, now on your side, you're sitting there. I got a big problem trying to solve these problems. I got patients that want better outcomes. They want to live. I don't want to throw away kidneys. I don't have to. You just solve that problem. Now, when they bring that over, what was it like over on your side of the house as a practitioner deploying it? You've got two jobs going on. You're kind of doing IT integration on one hand and you're a surgeon on the other trying to make things happen. You know, what I see this is not a lot of IT here. What's the deployment look like? Yeah, deployment to me is, I don't know why everyone else isn't doing it. It's such a straightforward, easy situation. It's remarkable, really. It's such a good solution. I think part of any sort of change management program, and this again is change management. It's challenging the way we think about things. It's challenging people's comfort zones. And anytime we need to change, we've got this anatomy of change. We've got innovators. We've got early adopters. We've got late adopters. And I think what we're going to see over the next five to 10 years is people recognizing that this technology is a game changer, possibly being driven by their patients who say, I want a 3D model and I want to see what this actually looks like because basically that black and white picture you're showing me doesn't make any sense to me. And I think there's going to be the two drivers. The first is that we want to have consistency of care and a lack of variation in our care across all services. But as well as that, the patients, I think are going to drive this as well. So once we get the innovators and the early adopters of this technology on board, then we'll see a tipping point. And that's when it becomes an acceptable and normal thing for people to do when they come into hospital. They'll be shown a 3D printout model of their pathology. And that'll be used to inform their decision making for their treatment processes. And that's a true collaboration between doctor or surgeon and the patient. And that's where we need to be in the 21st century. It's got to be a collaborative decision making process. And you talked about patient journeys and this is a really integral part. This is the roadmap of your journey to a large extent. So I think I can see this being rolled out worldwide, being driven by patients and by a correction variability of healthcare provision. It's a great example. And it's an innovative award winner for the most innovative use of artificial intelligence and machine learning, 3D images, saving lives. Congratulations, Tim, Roger. It's phenomenal. Final question as we end this out. What's the scar tissue? Pun intended, what did you learn? What are some of the things that you could share with folks as people look at this and say, this is an example of cloud scale and technology for good. What lessons have you learned? What can you share for folks? Take a minute to explain each, but Roger, we'll start with you. Yeah, sure. So I think a number of lessons for us on this journey as Tim says, this is a, we're at the start of a journey of understanding the power of what 3D imaging can bring just to providing consistent or lose variable care. But also, as Tim also alluded to in terms of the patient understanding, I think that patient understanding is one of the hugely forwards that we didn't set out initially thinking we're going to be able to help educate and better inform patients. But that was one of the derived benefits that suddenly became apparent. So that was a great lesson. I think the incredible levels of adoption that we're starting to see across the US, across Europe, because it's so easy to adopt compared to traditional IT methods, surgeons just register for our website and they can start transacting and getting service from us as opposed to having to have these huge IT programs. So I think we're now starting to really scratch the surface and start seeing the benefits of this isn't an administrative system, it's not an EHR system, it's not a finance system where maybe healthcare was comfortable in using public cloud. This is core, hardcore clinical services, clinical diagnosis, clinical education and the Amazon cloud is enabling that, it just wouldn't be possible without this technology. We're at the start of that journey. The lessons we're learning are just my memory. Dr. Tim Brown, take us home in the segment with your take, lessons learned and advice to others. I think the lessons learned are that doctors and healthcare providers are all extremely wary of change of new innovations because they feel that already they're overburdened, probably my colleagues in the States and across Europe feel like me, we're a bit overburdened by all the things that we have to do and this may potentially have been a more difficult or adds to your workload and actual fact, this makes your workload a lot easier and convincing people and getting people to understand that this really does make your life a lot easier. It actually removes all the scar tissue, it removes the difficulties that have been put in place by organisations and once people realise that that's what, that there is no heavy lifting and this will make a huge difference to your practice and to your patients understanding of your practice and once that people really realise that then the tipping point will be achieved and I'm looking forward to that day because this is going to be the new normal in the next five to 10 years. Well, the performance that you're putting off the numbers of 90 transplants successfully over six weeks dwarfs the full year last year really kind of shows the outcome as a game changer and again, congratulations on your success. Roger, thank you for coming on, congratulations on being the award winner AWS Partner for the most innovative AI and machine learning solutions. Thanks for taking the time for part of this. AWS Partner Awards Program, thank you. Thank you. Okay, I'm John Furrier, we're covering the AWS Public Sector Partner Awards Program put on by theCUBE and AWS Public Sector Partners. Thanks for watching.