Detecting and Monitoring Stroke in China Using a Low-Cost, Portable Microwave Scanner (DeMoStroke)

The impact of stroke incidents is immense: five million people die and another five million are permanently disabled every year due to stroke incidents, and stroke is placed third among reasons for acute death and first among reasons for neurological dysfunction in the western world. Its impact and consequences, however, are even more devastating in developing countries, where according to WHO estimates, death from stroke accounted for 85.5% of stroke deaths worldwide in 2001, and the number of disability-adjusted life years (DALYs), i.e. years of life lost and years lived with disability, was almost seven times higher than in high-income countries. In China, in particular, stroke is the leading cause of death, and it strikes earlier in life than it does in the western world. Its treatment relies to a great extent on the information provided by diagnostic methodologies, which are necessary to guide medical experts in choosing a treatment strategy and to assess its efficiency.

This project will build on existing expertise by the project partners in the UK and China towards the development of a portable and low-cost system which can detect the occurrence, and monitor the evolution of stroke and its treatment using microwave technology. The proposed system will use low-power, non-ionizing radio waves (microwaves) to image the occurrence and evolution of stroke in an accurate manner, thereby removing the need for expensive imaging systems (such as CT scans) which would result in significant delays in treatment decisions.

This approach can address several clinical needs. For example, the system can be used inside an ambulance to determine the type of stroke much earlier than CT scanners inside a hospital. This is particularly important for ischemic stroke patients (which account for over 80% of total cases), for which early detection is crucial for thrombolytic treatment (i.e. blood thinners that can dissolve clots in blood vessels due to ischemic stroke but would worsen the condition of a blood vessel rupture occurring in hemorrhagic stroke). Moreover, by serving as a point of care diagnostic tool for patients at their homes, the proposed approach can lead to more efficient management of stroke in the post-acute stage, which can improve the potential recovery of the patient. The scanner can therefore revolutionise stroke therapy and recovery in communities where CT or MRI equipment is scarce or not available, such as underdeveloped or rural areas in China and other ODA countries.

The project will develop the microwave device relying on academic and industrial UK expertise in microwave imaging algorithms and instrumentation. In addition to offering academic expertise in microwave medical imaging, the project's ODA partners will accelerate the proposed device's pathway to clinical use through a network of hospitals and medical centres and cooperation with over 35 hospitals across 30 cities in China in the planning of clinical trials. Although delivered in China, the project can make a difference in many developing countries where stroke is emerging as a health threat also for younger populations (e.g. South Asian countries), as the targeted device will be affordable and simple enough to use.

Computed tomography (CT), magnetic resonance imaging (MRI) are commonly used to detect and monitor stroke. These technologies have significant drawbacks such as cost and access (CT and MRI), even for developed countries. In the UK, for example, there are only 9 CT scanners per 1 million people. In addition, CT and MRI machines require large infrastructure, so that tests can be only done in hospitals and require significant time (reporting, ambulance) to transport the patient to the facility, which is a major drawback for treating a stroke patient. In underdeveloped or rural areas, where a large percentage of the population lives in developing countries (e.g. 60% in China), CT or MRI equipment is scarce or not available at all, and therefore there is an immediate need for a new, affordable, and easy to use technology. The project can therefore make a significant difference towards a personalised treatment of stroke worldwide, which is impossible currently as stroke imaging relies on CT and/or MRI screening.

The proposed low-cost, portable device will be used inside an ambulance as a mobile stroke unit to detect stroke type and determine treatment much earlier, and as a patient point of care device which can monitoring stroke evolution after the onset from home. By offering a bedside stroke monitoring tool that can provide images to doctors remotely to help them develop patient specific treatments, the project can save and improve the lives of millions of patients, and ultimately save tremendous amount of money for healthcare public sectors.

Beyond stroke, the proposed technique could be adjusted to other diagnostic applications where portability and point of care diagnosis is critical, such as early localization of hematomas from traumatic intracranial injuries inside an emergency vehicle. Different to hemorrhagic strokes, blood accumulates in more superficial areas in these traumatic lesions, which makes it easier for microwaves to probe and diagnose. Moreover, the monitoring concept underlying the developed technology could also be used in the follow-up of therapies for other kind of diseases, such as monitoring the effectiveness of anti-cancer chemo- or radiotherapy, by tracking the changes in the tumor affected tissue (for example, to observe the reduction rate of the tumor after a chemo-therapy cycle).

Aside from specific applications for the proposed device, the project will have huge impact on establishing microwave technology as a diagnostic tool for medical applications. By focusing on its advantages (low cost, portability), the project will demonstrate the potential of microwaves as a diagnostic tool in applications and situations where these factors are critical and access to more accurate but expensive imaging devices is difficult or impossible. This will motivate a number of academic groups and industry to engage in this area, thereby leading to a renewed interest in R&D for microwave imaging, leading to further reductions in the cost of the necessary hardware for microwave medical imaging devices (as has been the case for the telecommunications industry, for example).

The project will also have significant impact on the project partners. First, the proposal is a unique opportunity to develop a preclinical prototype of a very sophisticated and innovative diagnostic system. The project's UK industrial partner, MediWise, will become the future commercial distributor of the product in the UK, Europe and North America, thereby achieving significant growth in the competitive medical market. Similarly, the ODA industrial partner, ET Medical, will have the opportunity to become a leading industry in this area in China. The academic partners will also benefit immensely, as they will have the opportunity to expand their technological expertise by integrating their research methods into a clinically approved prototype that can translate their methods into useful diagnostic information.