CLEVELAND — Could David Letterman do it any better?

The second edition of the already popular Top Ten list of medical innovations for the year 2008 was presented on the final day of the Cleveland Clinic-sponsored Medical Device Innovation Summit.

Introducing the Top Ten panel, Chris Coburn, executive director of CCF Innovations — the technology transfer arm of the clinic — described the process by which this year’s list was compiled.

In the early stages, he said that about 50 thought leaders at the clinic were interviewed and provided their picks. These interviews produced a list of about 100 candidate technologies “that in the opinions of our thought leaders will be at a breakthrough level in their field in 2008.”

According to Roy Greenberg, MD, assistant professor of surgery and director of endovascular research at the clinic, the list was further paired down to a group of about 40 items, and a panel of 20 physicians then ranked these.

He said that ranking the innovations was a bit of a challenge “because we’re somehow trying to compare apples with oranges. How do you compare a genomics project with a percutaneous valve, or something like that, which is a bit of a challenge?”

Surprisingly, Greenberg said, there was frequent convergence among the experts making the selections.

“When you look at medicine and the effect of these new inventions on the medical community at large, there’s a lot of agreement between them. This year there were not actually any arguments about what should be on the Top Ten list and what shouldn’t.”

Thus — imagine a drum roll here — we present the clinic’s Top Ten medical innovations for 2008, last to first, in Letterman style:

10. Dual energy source computed tomography (CT): CT scanners use two radiation sources and detectors, speeding medical imaging and exposing patients to less radiation. Presenter Thomas Masaryk, MD, head of the clinic’s neuroradiology section, said such scanners will enable the imaging of patients with high or irregular heart rates, previously a limitation for imaging. “Dual energy CT improves speed, both spatial resolution and temporal resolution and it allows for [excellent] tissue characterization,” said Masaryk.

9. Engineered cartilage products for joint repair: Natural biomaterials are used to replace joint cartilage tissue damaged from injury or arthritis. The engineered cartilage is surgically implanted into the joint with the intent to avoid artificial joint replacement. “This is clearly going to be a large, expanding area in 2008, 2009,” said presenter Joseph Iannotti, MD, PhD, chairman of orthopedic surgery at the clinic.

8. Neuromodulation implants/Brain stimulation: Neural control devices that could restore movement of arms and legs to patients with spinal chord injuries, stroke ALS and other central nervous system injuries. Ali Razi, MD, director of for the clinic’s Center for Neurological Restoration, said that researchers are only now glimpsing the tip of the iceberg with this technology. “Basically, the era of the brain chips is here,” Razi said. “This is not science fiction anymore it’s here being translated into human beings and the applications for the future are enormous.” He likened the level of sophistication for these systems to cardiovascular implant technology 20 or 30 years ago.

7. Image fusion for diagnostic and therapeutic use: Merging of different medical technologies to better diagnose both anatomic and physiologic problems and guide minimally-invasive procedures. Why is this being considered an innovation now? According to Greenberg, who presented this technology for the panel, “the image resolution ... has increased to the point where it’s becoming very useful.”

6. Nasal drops that deliver flu vaccine to infants: Nasal drops containing live attenuated flu can be used to deliver a vaccine instead of needles and provide protection from influenza for this high-risk population as young as 6 months of age.

5. New drugs to prevent blood clots or bleeding: Newer anticoagulant treatments, which include low molecular weight heparins, are being introduced to reduce complications such as bleeding or thrombosis. Presenter John Bartholomew, MD, section head of vascular medicine said that based on the successful development of anticoagulants made from leeches, researchers are looking into developing other compounds from blood-sucking creatures like fleas, ticks and bats.

4. Genome-based personalized medicine: Genetic testing that can produce personalized health risk assessments to guide therapy that will head off disease before symptoms are seen.

3. RNA anti-sense technology: Gene-based therapies that reduce a protein that carries the “bad” cholesterol and triglycerides in the bloodstream. This could potentially help to reduce heart disease. The technology is already being studied for use in the treatment of age-related macular degeneration of the eye, and according to presenter Peter Kaiser, MD, a staff member at the clinic’s Cole Eye Institute a compound is already in Phase II studies for that indication. He compared the mechanism of action of this RNA anti-sense technology to shutting off a faucet at its source, thus preventing a cascading effect further downstream.

2. Percutaneous aortic heart valves: Aortic heart valves can be delivered via catheter through a groin or small incision in the chest wall and then expanded inside the heart. X-ray screening lets doctors monitor the valve as it is positioned. Lars Svensson, MD, PhD, a staff member in the clinic’s department of Thoracic and Cardiovascular Surgery, said that currently, about 48,000 aortic valve replacements are done annually in the U.S. He said that more than 125,000 patients in the U.S. with severe aortic stenosis could benefit from this type of procedure.

1. Flexible intralumenal robotics: A catheter-based technology to let surgeons manipulate tiny tools, in places where their hands don’t fit, such as inside the heart. The flexible robotic system could be used for cardiology, neurology, urology and other specialty procedures. “This does represent a new paradigm of robotic surgery,” said presenter Inderbir Gill, MD, section head at the clinic’s transplantation center.