Dr. Kevin Most: Watson and healthcare, blood clot removal, and mobile stroke units
Watson and Healthcare
If you caught 60 minutes last Sunday, you saw a segment on what IBM is doing with Watson, the computer everyone remembers for playing Jeopardy. The expansion of what Watson is doing is quite amazing and in healthcare it may become game changing. Currently for many Oncology cases the treatment plan is discussed in a session term Tumor Board. In this meeting you have a large group of physicians review a patients case and come up with the best treatment plan known to them. This takes into consideration recent results of clinical trials, active trials in place, new medications, new imaging options, surgical….. The list goes on. You can have brilliant well read experts in the field and yet have they read everything and do they remember everything?
This is where Watson has come into play. Watson has been “fed” the information needed to help in these decisions, and is continuing to be fed the results of thousands of papers that are completed each week. It is now being taught how to take that information and couple it with current outcomes data to come up with suggested treatment plans. Pair this with insurance data, cost of care data and availability of medications and we may be redesigning how we treat the patient with cancer.
It is also being taught how to read complex radiology studies by comparing normal scans with abnormal scans and looking for differences. This could revolutionize how we review CT scans, MRI’s and x rays. The concept of Artificial Intelligence in imaging is not new. But it is coming more of a possibility. Lets put things in perspective a busy radiologist will read 20,000 studies in a year. The current plan is to have Watson review 30 billion images as IBM purchased a company that stores images. It is then being taught what is normal and what is not and what disease showed the change in the imaging study. Once taught, it is thought that Watson may be able to identify subtle changes of early disease that we as humans would not notice. Watson is in its infancy for this but experts are not say will computers start reading images but instead are say when they will. Some estimates are that within 10 years we will have computers reading x rays with confirmation done by the physician. If we look at the advances being made in all areas of technology this time line sounds appropriate.
Having Watson present to help with tough healthcare decisions that require a lot of data that no one person could acquire will change the way we practice.
Blood Clot Removal For Stroke Patients
We have discussed Strokes many times in the past, we know that a stroke is essentially a heart attack in the brain. What I mean by that is we know heart attacks occur due to blockage of blood vessels that supply blood and oxygen to the heart muscle. The same thing happens with a stroke , in many cases it is caused by blockage of an artery that is supplying blood and oxygen to the brain. We know in heart attack patients that the sooner we get the artery cleared and blood flow restored the less damage we do to the heart. This is done by opening up the artery with angioplasty, stent placement or in some cases bypass surgery. We also know that clot busting drugs can also help restore blood flow quicker.
The heart is a bit more resilient than the brain, we can damage a portion of the heart and the hearts pumping ability can be maintained. The sooner we restore blood flow the less chance for damage to the heart muscle. The same is somewhat true for strokes as well, however depending on where the blockage is the outcomes can be more permanent and debilitating. We have know or have seen someone who has had a stroke and the residual damage done by the stroke. The brain is much more fragile and also more specialized in areas than the heart is.
Our treatment for strokes is often limited to using the clot busting drug TPA. For TPA to work it must be given quickly as it takes time to work. We have found out that delivering the TPA directly to the clot via a catheter is helpful in dissolving the clot quicker. Some hospitals are fortunate to have highly specialized physicians who are trained to go in and remove the clot using catheters that go into the blood system in the brain. It is absolutely fascinating and the outcomes are amazing. The patient in the past who would have been forced to use a wheelchair for ambulation are being discharged a day later with no deficits when the clot is removed in a timely fashion.
We have always known and it makes complete sense that the earlier we can restore blood flow to the brain the less chance of long term damage. Last week in JAMA a study showed that restoring blood flow even after seven and a half hours had many patients with very good recovery. In the past we started with a low number of hours that we needed to restore blood flow and now the newer devices allow for better blood flow restoration as well as ability to remove more clots. This has extended the time frame for which we will consider attempting to remove a clot.
Mobile Stroke Unit
When we think of time, we are trying to save off minutes as we know the importance of time and brain function. Currently a patient maybe having signs of a stroke and they call 911, the paramedics arrive, and see a stroke is occurring. Their goal is to get the patient to the hospital as soon as possible. Upon arrival to the hospital a CT scan is done quickly. This scan allows for a quick diagnosis between a stroke caused by a bleed, a broken blood vessel and a stroke caused by a clot. Once determined it is caused by a clot the blood thiner medication is given to the patient and those institutions that can remove a clot do so quickly. Those institutions that can’t prepare the patient and transport them to a hospital that can remove the clot. Time and environment often have an impact on these patients.
Recently a few areas across the country have looked into ways to shorten that time. In a few cities, soon to be western suburbs of Chicago, hospitals have said, “Why can’t we scan the patient faster” That is a great idea, do we tell the ambulance drivers to drive faster? No instead we will be bringing the CT scan to the patient. Northwestern Medicine CDH is one of a few places in the country where an ambulance with a CT scanner in it will be sent to homes where the 911 call describes the symptoms of a stoke. This special ambulance will allow for the patient to have the CT immediately, with the images sent to the hospital for review. Patients who are having a stroke due to blockage will be given the clot busting drug immediately and the hospital will be notified to have the stroke team ready for the patient. This will allow for more timely interventions.
For storkes caused by bleeding and not a clot, those patients would not be given the clot busting drug as it would make this type of stroke worse and a neurosurgeon will be called vs the interventional radiologist as this person needs repair of the broken blood vessel if possible.
The mobile stoke unit for Northwestern is being built right now and we hope to have it up and operational by early next year. This technology will allow us to cut minutes off the time of blockage and restore blood flow to the brain sooner allowing for better outcomes. This has all been funded with donation dollars from the Northwestern Medicine Foundation. This may make a huge impact and many think that this will be the standard of care everywhere as the price of equipment comes down and the advancement of technology goes up.