We are living in unprecedented times.

COVID-19, a novel coronavirus for which humans have no immunity, is wreaking havoc across the globe. Businesses, schools, bars, and restaurants are closed indefinitely, and people are ordered to stay inside and practice “social distancing”. The economic damage is estimated to be several trillions of dollars. While we know this COVID-19 wave will pass eventually, it is of paramount importance that we act now to be better prepared for the next respiratory pandemic. There is scientific consensus that the probability is high that this virus will return in a few months. The quarantine measures that were imposed are effective and will slow down the infection rate but at the same time, they will also delay herd immunity. Herd immunity is needed to be able to live a normal life alongside a virus such as COVID-19. To prepare for what is to come, we need to understand the root cause of the disruption we face today and work towards solutions in the short, medium and long term. We are hopeful that our Functional Respiratory Imaging (FRI) can be part of the solution.


Members of the consortium are, amongst others:

Fluidda’s blood volume (BVX) biomarker used in triage for COVID-patients

Due to the very large number of Corona patients who now report daily for hospitalization, it is becoming increasingly important to only admit those patients to an Intensive Care Unit who will benefit most from this, as the number of beds is limited. Since November 2020 AZ Delta Hospital is the first hospital to make structural use of Functional Respiratory Imaging to organize the treatment of all COVID-19 patients as efficiently and optimally as possible.

The technology – currently applied in several clinical studies – demonstrates the importance of the small blood vessels in the lungs of COVID-19 patients, so that it can be used to determine the best treatment for each individual patient. Our research has shown that small blood vessel volume is severely impaired in COVID-19 subjects, and analysis has shown that investigating the blood vessel volume in these smaller vessels is predictive of intubation and mortality. This allows doctors to make more informed decisions, and by using FRI imaging the hospital hopes to be able to provide optimal care to the still increasing number of people who have contracted a COVID-19 infection.

What are the effects of COVID-19 on the lungs?

COVID-19 is a Coronavirus that attaches to the ACE2 receptors in the lung. As with all infections, the human body activates its immune system to fight off the infection by producing inflammatory cells. However, in a small percentage of the population the immune system over-reacts and ends up flooding the lung with edema, a liquid consisting of the inflammatory cells. This condition is called Acute Respiratory Distress Syndrome or ARDS. ARDS patients require very intensive care including invasive mechanical ventilation for several weeks. While the overall percentage of people developing ARDS is low, if many people get infected at the same time the absolute number of patients requiring intensive care can be very high and can lead to a near-collapse of the healthcare system in certain areas. One of the primary solutions to the current crisis is the ability to identify patients with a high risk of developing full-blown ARDS early and intervene accordingly to prevent the patient from ending up in the ICU for a long time. Early ARDS can be treated by using less complicated ventilators such as CPAP, more advanced masks and potentially by a range of anti-inflammatory drugs. One of the major problems with early diagnosis is that the lung has a remarkable capability of compensating for a disease that is already present. The lung can be already quite affected by the disease without symptoms or function decline, as measured with the conventional lung function tests. This clinical image is reported in COVID-19, many patients are doing ok for around 7 to 10 days after which some of them rapidly decline. Hence, early detection of the level of ongoing compensation is of critical importance.

What is FRI and why is it better than traditional methods?

Functional Respiratory Imaging or FRI is a technology developed by Fluidda over the last 15 years. FRI combines high resolution, but low radiation dose, CT images with computer methods developed in the aerospace world. FRI converts the CT scans into three-dimensional reconstructions of anatomical structures such as airways, blood vessels, lung volumes, etc. and uses accurate computer simulations to add a unique level of functionality to the scan output. The output of an FRI analysis is a very accurate description of how healthy or diseased the lung is on a regional level. As such, it allows the physicians to understand if this lung is already compensating for disease and is therefore at risk of rapid decline in the near future. If so, the physician can intervene early and prevent clinical worsening.

Fluidda’s technology received FDA clearance [1] earlier this year and is supported by FDA for use in clinical trials [2]. The greater sensitivity of FRI compared to spirometry results in significantly smaller and shorter clinical trials. Consequently, FRI has been used extensively in clinical studies to enhance drug development for asthma [3], COPD [4], Idiopathic Pulmonary Fibrosis [5], Cystic Fibrosis [6], Pulmonary Hypertension [7] and Acute Respiratory Distress Syndrome [8]. FRI has generated unique insights into the disease of ARDS and the effects of mechanical ventilation which forms a solid scientific basis for further development.

What can fri do to help long term?

FRI has been demonstrated to be accurate in predicting clinical outcomes whether it is an imminent exacerbation in a COPD patient [9] or the rejection of a transplanted lung [10]. The high accuracy is a result of a superior determination of the true disease severity. Patients with more diseased lungs, often without symptoms but detectable with FRI, have a higher probability of poorer clinical outcomes over time. These principles will be used to develop a predictive algorithm for COVID-19 related ARDS to determine whether an individual patient is at risk of developing full blown ARDS in the short or medium term. High risk patients can be monitored more closely, can receive non-invasive ventilation and are candidates for drug treatments.

What can you do to help?

If you or anyone you know has been infected with COVID-19 and a CT scan was taken,
please get in touch with us at covid19@fluidda.com.

We will analyze your scan free of charge in return for your permission to use the anonymized data to develop predictive algorithms to save lives.


[1] https://www.accessdata.fda.gov/scripts/cdrh/…
[2] https://www.fda.gov/drugs/…
[3] Hajian B et al. Expert Opin Drug Deliv. 2016 Dec;13(12):1719-1727.
[4] De Backer W et al. Int J Chron Obstruct Pulmon Dis…..
[5] Wu X et al. Am J Respir Crit Care Med. 2019 Jan 1;199(1):12-21.
[6] Bos A et al. PLoS One. 2015 Mar 3;10(3)
[7] Hajian B et al. Int J Chron Obstruct Pulmon Dis. 2016 Jul 5;11:1533-41.
[8] Schepens et al. Anaesth Crit Care Pain Med. 2020 Feb 7
[9] Lanclus M. et al. Acad Radiol. 2019 Sep;26(9):1191-1199.
[10] Barbosa E. et al. Acad Radiol. 2018 Sep;25(9):1201-1212.