In the U.S., someone has a stroke every 40 seconds and dies from it every three minutes and 14 seconds, according to the Centers for Disease Control and Prevention. When it comes to stroke, experts echo the fact that time is brain. Faster treatment translates to better outcomes, and certain treatments, like the clot-busting drug tPA, have a strict time window for administration.
Credit: Medical University of South Carolina. Photograph by Sarah Pack.
In the U.S., someone has a stroke every 40 seconds and dies from it every three minutes and 14 seconds, according to the Centers for Disease Control and Prevention. When it comes to stroke, experts echo the fact that time is brain. Faster treatment translates to better outcomes, and certain treatments, like the clot-busting drug tPA, have a strict time window for administration.
“The quicker that we can get the patient to treatment, the quicker we can have a good outcome,” said Dustin LeBlanc, M.D., director of Prehospital Medicine and associate chief medical officer for Emergency Management at the Medical University of South Carolina (MUSC). “But the big step in between – that is diagnostic studies.”
To accelerate diagnostic studies, a team of MUSC researchers, including LeBlanc, partnered with Charleston County Emergency Medical Services (EMS) to equip an ambulance with a portable MRI. The team was led by Donna Roberts, M.D., professor in the Department of Radiology and Radiological Sciences at MUSC and the deputy chief scientist for the International Space Station National Lab, and included Jillian Harvey, Ph.D., a professor in the College of Health Professions. Their findings, reported in the October issue of the Journal of Stroke and Cerebrovascular Diseases, showcased the potential of the MRI-equipped ambulance.
An earlier trial in collaboration with Georgetown County EMS laid the foundation for this human trial by showing that images could be obtained in a moving ambulance on a standardized calibration model.
The project received funding from MUSC’s Blue Sky Award program, aimed at supporting high-risk research that tackles major medical and scientific challenges.
How the device could improve stroke care
Roberts thinks the new technology could be a game-changer for stroke care decision-making.
“If you’re somebody who could just receive tPA, you might go to a local hospital, while those who need to have advanced procedures, such as interventional neuroradiology, would go to a different hospital,” she said. “The imaging provided by the portable MRI scanner in the ambulance could help make that decision.”
Harvey thinks that it will also speed up stroke response times.
“If we can get that information in transit and the decision process going before they even arrive at the hospital, then we can shorten the time to care and treatment,” she said.
Harvey is working with Kit Simpson, DrPh, also a professor in the College of Health Professions, to analyze state stroke data to see where MRI-equipped ambulances are most needed.
“The real benefit may come in rural areas where patients may be hours or further away from an MRI,” said Harvey.
For LeBlanc, it’s all about how cutting-edge technology can transform and improve patient care.
“If you think about where defibrillators were 50 years ago, they were hundreds of pounds, and it really took out-of-the-box thinking to imagine they could be portable. And now, they’re public access points,” he said. “The MRI-equipped ambulance is just another example of technology helping us to develop ways to make things faster, lighter, smaller, more portable and to get it to the patient as quickly as possible.”
Ambulances equipped with CT scanners, known as mobile stroke units, are already used by some medical centers. However, they have limitations, including radiation exposure. The portable MRI has no radiation risk, and because it has a much lower magnetic field than traditional MRI, safety concerns regarding metal near the system are minimized, allowing operation of other medical or electrical equipment. Traditional MRI imaging can also identify stroke patients without a clear stroke timeline. Further research will determine if portable MRIs can achieve the same.
Taking the MRI-equipped ambulance for a trial run
The research team worked with Charleston County EMS to secure a portable MRI in one of its ambulances and capture imaging while driving slowly around a parking lot, which had been blocked off with the help of MUSC Facilities. During the trial run, the research team obtained imaging of a healthy volunteer. Diagnostic-quality images were obtained and successfully transmitted to hospital radiologists for review.
“This was really a team sport, with all aspects of MUSC and Charleston County EMS coming together for the mission of research,” said LeBlanc.
The road ahead
Despite these early promising results, more work needs to be done to see if diagnostic-quality images can be obtained when the ambulance is traveling at full speed. The team is also working with the Clemson School of Engineering to optimize the ergonomic fit of the MRI in the ambulance. With further technological advancements and clinical studies, MRI-equipped ambulances could become a game-changer in the field of emergency medicine, ensuring that stroke patients receive the best care possible, even before they reach the hospital.
“Ultimately, we need to stop thinking about telling patients to come to us,” said Roberts. “Instead, we need to be thinking about how we can take medicine to the patient.”
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About MUSC
Founded in 1824 in Charleston, MUSC is the state’s only comprehensive academic health system, with a unique mission to preserve and optimize human life in South Carolina through education, research and patient care. Each year, MUSC educates more than 3,200 students in six colleges – Dental Medicine, Graduate Studies, Health Professions, Medicine, Nursing and Pharmacy – and trains more than 900 residents and fellows in its health system. MUSC brought in more than $298 million in research funds in fiscal year 2022, leading the state overall in research funding. MUSC also leads the state in federal and National Institutes of Health funding, with more than $220 million. For information on academic programs, visit musc.edu.
As the health care system of the Medical University of South Carolina, MUSC Health is dedicated to delivering the highest-quality and safest patient care while educating and training generations of outstanding health care providers and leaders to serve the people of South Carolina and beyond. Patient care is provided at 16 hospitals (includes owned and equity stake), with approximately 2,700 beds and four additional hospital locations in development; more than 350 telehealth sites and connectivity to patients’ homes; and nearly 750 care locations situated in all regions of South Carolina. In 2022, for the eighth consecutive year, U.S. News & World Report named MUSC Health University Medical Center in Charleston the No. 1 hospital in South Carolina. To learn more about clinical patient services, visit muschealth.org.
MUSC has a total enterprise annual operating budget of $5.1 billion. The nearly 26,000 MUSC family members include world-class faculty, physicians, specialty providers, scientists, students, affiliates and care team members who deliver groundbreaking education, research, and patient care.
Journal
Journal of Stroke and Cerebrovascular Diseases
DOI
10.1016/j.jstrokecerebrovasdis.2023.107301
Subject of Research
People
Article Title
Mobile point-of-care MRI demonstration of a normal volunteer in a telemedicine-equipped ambulance.
Article Publication Date
12-Aug-2023