Stroke care looks skyward with new mobile CT program

2019 09 10 22 04 6858 2019 09 11 Mobile Ct Thumb

The notion that stroke care could one day take to the skies seems more likely now than ever. Researchers from Australia have launched a new research program tasked with developing portable brain CT scanners that can be installed onboard aircraft to give rural areas access to faster stroke intervention.

The project, led by Drs. Geoffrey Donnan and Stephen Davis of the University of Melbourne, aims to advance the efficiency of emergency stroke treatment, especially for people living in rural areas who have limited access to hospital care. The Australian government recently endowed the research team -- which includes experts from more than 30 institutions in Australia -- with a grant of $1 million Australian as part of the government's Medical Research Future Fund Frontiers initiative.

Drs. Geoffrey Donnan and Stephen Davis.Drs. Geoffrey Donnan and Stephen Davis.

Since the early 2000s, land-based mobile stroke vehicles have demonstrated the capacity to improve treatment times for stroke care in various metropolitan regions throughout the U.S. and Europe, with some 20 ambulances operating worldwide. One is in Melbourne, where the unit is equipped with CT and other gear to provide onboard stroke diagnosis as well as thrombolytic therapy.

A major motivating factor behind the new research program is to bring the kind of stroke care available in urban areas to rural and remote regions of Australia, where there is little access to advanced procedures such as thrombectomy, Donnan and Davis told The physicians are co-chairs for the program and both previously served as presidents of the World Stroke Organization.

"Should we be successful with the research program, it will have implications for the models of stroke care in Australia and other countries as well, and any continent where remote regions have more difficulty getting access to top-line acute stroke care," Donnan said.

"The project also has relevance to urban regions, because miniaturizing CT imaging systems would allow us to put these systems in a significant proportion of existing mobile intensive care ambulances related to myocardial infarction and cardiac arrest," Davis added.

Walter et al first proposed the concept of an air-mobile stroke unit in a 2018 article, in which they described how clinicians would be able to manage various aspects of stroke care in an aircraft equipped with a customized CT scanner (International Journal of Stroke, August 2018, Vol. 13:6, pp. 568-575).

One of the main challenges facing the realization of this proposition has been reducing the weight of a standard CT scanner, which weighs approximately 1 ton. Donnan, Davis, and colleagues have been looking at the latest innovations in CT technology and other potential imaging options involving electromagnetic waves to determine the best way to develop more lightweight scanners that could be taken airborne.

Proposed layouts for a mobile CT air ambulance. All images courtesy of Drs. Geoffrey Donnan and Stephen Davis.Proposed layouts for a mobile CT air ambulance. All images courtesy of Drs. Geoffrey Donnan and Stephen Davis.

"We are just at the very beginning of the project and it may take up to 10 years," Donnan said. "It's in the early days, but we both agree that it's one of the most ambitious projects we've ever taken and, if successful, one of the most meaningful."

The researchers are currently in talks with several major OEMs and small startups regarding the miniaturization of CT technology for the air-mobile stroke units. Once they complete that component of the project, they plan to conduct a systems-based study to determine whether the stroke unit is cost-effective for continued use.

"To be sure, the full suite of offerings won't be available for quite a few years," Donnan said. "But if and when the research project is completed successfully, it will not only be a benefit to people in Australia, but the global implications are quite significant as well."

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