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Imagine if a simple blood test could detect recurrent cancer earlier, while also predicting a patient's prognosis, Cleveland Clinic physicians say. Or imagine if a device the size of two decks of cards could help a paraplegic breathe without a bulky ventilator. Or imagine if a machine could essentially keep harvested organs alive until they're transplanted in the recipient.

Now imagine that these innovations already exist, because they do, along with seven other emerging technologies that make up Cleveland Clinic's Top 10 Medical Innovations for 2009. The list of breakthrough devices and therapies was selected by a panel of Cleveland Clinic physicians and scientists and was unveiled during Cleveland Clinic's recent 2008 Medical Innovation Summit.

The innovations touch on avian influenza, electronic medical records, and various minimally invasive surgeries to treat uterine fibroids, to repair heart valves, and to remove organs through the body's natural orifices.

"Once again, we are seeing a diverse list of technologies that have the potential to make an enormous medical impact in the near future," said Michael Roizen, M.D., who chaired the Top 10 Medical Innovations List.

The Top 10 Medical Innovations for 2009:

10. Private Sector National Health Information Exchange: A comprehensive system of electronic health records that link consumers, general practitioners, specialists, hospitals, pharmacies, nursing homes, and insurance companies is in the process of being established. Primarily a private-sector effort, this computerized system has the potential to replace paper-based medical files with digitized records of patients' complete medical history.

9. Doppler-Guided Uterine Artery Occlusion: Fibroid tumors occur in upwards of 40% of women older than 35, triggering pelvic pain, pregnancy complications, and heavy bleeding. There is a new, non-invasive approach to treat fibroids called Doppler-guided uterine artery occlusion, or DUAO.

8. Integration of Diffusion Tensor Imaging (Tractography): Diffusion tensor imaging (DTI) is the new technology that allows neuroscientists to non-invasively probe the long-neglected half of the brain called white matter, with its densely packed collection of intertwining insulated projections of neurons that join all four of the brain's lobes, allowing them to communicate with each other.

7. LESS and NOTES Applications: LESS (laparoendoscopic single-site surgery) takes laparoscopic surgery to an entirely new level by reducing the process to a small cut in the belly button. NOTES (natural orifice transluminal endoscopic surgery) bypasses normal laparoscopic incisions altogether. Instead, the surgeon gets to an appendix, prostate, kidney, or gallbladder through one of the body's natural cavities, such as the mouth, vagina, or colon.

6. New Strategies for Creating Vaccines for Avian Flu: A newer vaccine approach that uses a mock version of the bird virus called a virus-like particle (VLP) may offer a better solution to protect people against infection from the deadly avian virus.

5. Percutaneous Mitral Valve Regurgitation Repair: Using a tiny barbed, wishbone-shaped device, the heart is fixed non-surgically from the inside out. A catheter is carefully guided through the femoral artery in the groin, up to the heart's mitral valves. The clip on the tip of a catheter is then clamped on the center of the valve leaflets, which holds them together and quickly helps restore normal blood flow out through the leaflets.

4. Multi-Spectral Imaging Systems: The imaging system is attached to a standard microscope, where researchers can stain up to four proteins using different colors and look at tissue samples with 10 to 30 different wavelengths, allowing for the accumulation of more information than is currently available. This helps researchers to better understand the complicated signaling pathways in cancer cells, and to develop more targeted therapies, which might allow physicians to better personalize treatment for individual patients.

3. Diaphragm Pacing System: Four electrodes are connected to the phrenic nerves on the diaphragm. Wires from the electrodes run to and from a control box about the size of two decks of playing cards worn outside the body. When the electrodes are stimulated by current, the diaphragm contracts and air is sucked into the lungs. When not stimulated, the diaphragm relaxes and air moves out of the lungs.

2. Warm Organ Perfusion Device: Once a heart becomes available for transplant, surgeons have just four hours before the organ begins to decay. The perfusion device recreates conditions within the body to keep the heart pumping for up to 12 hours.

1. Use of Circulating Tumor Cell Technology: A blood test that measures circulating tumor cells - cancer cells that have broken away from an existing tumor and entered the bloodstream - has the ability to detect recurrent cancer sooner, while also predicting how well treatment is working and the patient's probable outcome. The test results will allow physicians to better monitor a patient's progress, adjusting treatment if necessary.

"Cleveland Clinic was founded by innovators, and this Top Ten list reflects the continuing passion for innovation of its scientists and clinicians," said Christopher Coburn, executive director, Innovations, the Cleveland Clinic's corporate venturing arm.

"Four major criteria served as the basis for qualifying and selecting the Top 10 Medical Innovations. Nominated innovations were required to:

-- Have significant potential for short-term clinical impact (either a major improvement in patient benefit or an improved function that enhances healthcare delivery).
-- Have a high probability of success.
-- Be on the market or close to being introduced.

For more information about next year's Medical Innovation Summit and the conference agenda, visit http://www.clevelandclinic.org/innovations/summit/default.htm .

About Cleveland Clinic Innovations

CC Innovations, the commercialization and innovation arm of Cleveland Clinic, organizes the Medical Innovation Summit, promotes innovation and is responsible for commercialization of all Cleveland Clinic technologies. CC Innovations advances product-oriented innovation and transforms promising therapies, devices and diagnostics into beneficial medical products, via spin-off companies, licensees and equity partnerships.