Use Robots and Ultrasound to Treat and Prevent Stroke

To effectively treat stroke and prevent stroke, you need to know just what is literally happening in a patient's head. CT Scans and MRI scans are tools most of us are familiar with. Generally if you suspect a stroke is possible, you need these two scans done.

There's another tool out there, too, that's cheaper, more portable, and involves no radiation. It's called Transcranial Doppler Ultrasound. It's a great complement to the other scans, and it can provide impressive insight to supplement the information from the radiologists. A skilled practitioner is a great complement to the care team.

I first talked about this technology in my conversation with Dr. Aaron Stayman a few years back (Is my Brain Pregnant? Ultrasound and Stroke: Transcranial Doppler Ultrasound). It's fascinating stuff.

The problem is that it does require a skilled technician or someone specifically trained in the technique. Despite the work of advocates like Dr. Stayman and Dr. Mar Rubin, there just aren't enough of those techs.

Dr. Mark Hamilton of Nova Signal has a solution. His robotic machine automates the whole process, makes it faster, more reliable, and cheaper while giving more accurate results in a lot of scenarios. The Nova Signal solution has the potential to make this technology available to patients and medical practitioners around the world.

Drs. Rubin and Hamilton join me in this episode to discuss the technology, the research, and the device itself.

If you don't see the audio player below, visit http://Strokecast.com/TCD to listen to the conversation.


Who are Drs. Rubin and Hamilton?

Dr. mark Rubin wears a suit and tie and faces the camera in this professional headshot in a library

Dr. Mark N. Rubin is a vascular neurologist and associate professor of neurology with the University of Tennessee Health Science Center Department of Neurology. He specializes in vascular neurology and is experienced in stroke and cerebrovascular disease, and an experienced sonographer and expert interpreter of carotid duplex ultrasound and transcranial Doppler ultrasonography.

He received his medical degree from University of Illinois College of Medicine and completed his Adult Neurology residency and fellowships (Neurohospitalist and Vascular Neurology) at the Mayo Clinic.

Dr. Robert Hamilton is outside in front of a tree wearing a light blue button down shirt with an open collar

Robert Hamilton, Ph.D. is the Chief Scientific Officer and Co-Founder of NovaSignal. He is an accomplished entrepreneur, engineer, and clinical researcher with a passion for innovative technologies that allow for increased access to care.

Robert, a biomedical engineer by training, is an expert in image/signal processing and machine learning, with extensive experience in cerebral blood flow, traumatic brain injury, stroke, and other neurological disorders. Robert co-founded NovaSignal based on technology he developed during his Ph.D.

During his tenure at the company, Robert has supported the entire lifecycle of the NovaSignal autonomous ultrasound platform from idea to commercialization with regulatory clearances in the US, Europe, and Canada. Additionally, Robert has designed and completed several clinical trials supporting the use of the technology in different neurological conditions and has acted as principal investigator on federal grants and contracts totaling more than $25M from the Department of Defense, National Institutes of Health, and the National Science Foundation. 

Finally, Robert has achieved greater than 100 citations of his work in peer-reviewed publications and conferences and holds over 50 patent assets related to the core technology developed during his PhD studies.

TCD vs Traditional Ultrasound

When most of us think of ultrasound in medicine, we think of the sonograms of developing children, where parents and doctors swear they can see a human being in those black and white lines. Personally, they seem more like those Magic Eye pictures from the 90s.

Traditional ultrasound can also capture pictures of the heart, the blood vessels in the neck, and the condition of other organs in the body. It can be another way of getting a picture of the structures at play.

And then you can frame those pictures or make them your Facebook profile picture.

TCD is different. The goal is not to capture a picture of the structures of the brain. The goal instead is to understand blood flow through the brain. The technology helps practitioners understand the rate of flow, where there may be leaks or disruptions, if stuff is flowing with the blood that shouldn't, the direction of flow, and whether things are shunting (or crossing) between the veins and arteries that shouldn't.

That shunting is at the core of the recent study Nova Signal was part of and that we talk about in this conversation.

There are several reasons shunting can occur, but one of the most common is a PFO, or a hole in the heart. I talked in more detail about just what a PFO is in the last episode here: http://Strokecast.com/Anna

TCD is a great technology for helping doctors understand the dynamic flow of blood in each individual patient. And it doesn't involve the dedicated rooms or radiation that might come with CT  or MRI Scans.

NovaGuide™ 2 Intelligent Ultrasound

The Nova Guide 2 Intelligent Ultrasound is the device we talked about in this conversation.

While TCD is a great tool, it does take a while to get the scan just right, and we face a dearth of practitioners who are able to do it.

The Nova Signal solution is simpler. It's small and automated. The device can orient itself and complete a scan much quicker than a human can. The research shows it's more accurate, too.

It doesn't take up much space in a medical facility and can easily be brought from one patient to another. Plus, an operator can perform a lot more scans per hour or get back to other tasks more quickly. With hospitals perpetually understaffed these days, that speed makes a lot of financial sense.

And since, in stroke, time is brain, it can make a lot of medical sense, too.

Nova Signal vs Transthoracic Echocardiography

The information about the presentation at the International Stroke conference is here: https://eventpilotadmin.com/web/page.php?page=IntHtml&project=ISC22&id=1176

This is the data we talked about a lot in the conversation. The Nova Signal device was significantly better at detecting the vein-artery shunts indicative of PFO and other conditions than the gold-standard  evaluation technique using Transthoracic Echocardiogram.

This matters in stroke because when we talk about shunting in tests we're usually talking about very small bubbles. Outside of the test context we're usually talking about clots and other stuff sneaking across from veins to arteries, bypassing the body's filters. When they do that they can go to the brain and cause a stroke.

Accurate detection of shunting allows physicians to make more appropriate treatment recommendations and decisions.

Hack of the Week

Cultivating a sense of gratitude, as unlikely as it may seem, is something that helps a lot of folks deal with the challenges pf post stroke life. Simply being alive means thing can get better. And being alive in the 21 century with the medical resources available is a huge asset to the community.

Of course those medical resources are not evenly distributed within the US and around the world, but they exist, and that's a start.

Develop a sense of purpose. After stroke, it can be hard to see a way forward, especially if you have severe disabilities. People who succeed in their recovery, or in their goals in general, typically have a pretty strong "Why?" driving them. Achieving their goals gets them closer to something important to them.

In the dark times, when you find yourself feeling it's just not worth it, your why -- your sense of purpose can give you a reason to push through.

We sometimes ask, "Why should I go on?" almost rhetorically to express or pain. For some folks, though, it can be an exercise to identify the things that matter to you. So ask yourself that question, but assume there is an answer. And write down everything that could be an answer.

Cultivate the sense of purpose to get through the darkness.


Where do we go from here?

Here is the latest episode of The Strokecast