Blue Sky Award winners will be first to use ambulance-mounted portable scanners to monitor stroke patients en route to the hospital

An interdisciplinary team of researchers at MUSC has received an inaugural Blue Sky Award for their study to determine whether equipping ambulances with a portable MRI scanner could reduce the time to treatment for South Carolina stroke patients in a cost-effective way. The team is led by MUSC Health neuroradiologist Donna Roberts, M.D.,  a professor in the College of Medicine, and evaluation expert Jillian Harvey, Ph.D., an associate professor in the College of Health Professions at MUSC. The Blue Sky Award, which will provide $100,000 in funding to test the feasibility of the idea, was created to reward such creative, out-of-the-box thinking and cross-disciplinary collaborations.

When a patient experiences a stroke, the clock starts ticking for receiving effective, emergent care. For patients with strokes caused by blood clots, tissue plasminogen activator (tPA), an important clot-busting drug, can help clear blocked vessels if given within a narrow time window. Because tPA carries a risk for increased bleeding, scans are needed before treatment to ensure that the stroke is not a brain bleed.

“Dr. Roberts asked me several times if [mounting a portable MRI into an ambulance] could be done, and to be honest I was kind of skeptical. Before I knew it, they had put the MRI in the back of an ambulance, driven around and taken pictures. And our jaws just dropped.” -- Christine Holmstedt, D.O.

“We know that the faster we treat people, the better the outcomes and the lower the risk of complications from the tPA,” said MUSC Health stroke neurologist Christine Holmstedt, D.O., a professor in the College of Medicine and a collaborator on the project.

MUSC Health has worked to dramatically shorten its door-to-needle time – the time from when a patient enters the hospital until the tPA is infused. For example, stroke neurologists already conduct virtual pre-scan evaluations of patients en route to the hospital, shrinking the time to treatment from 40 to 20 minutes.  However, Roberts and her colleagues thought more could be done to cut the crucial time lost while patients are transported to the hospital.

 

The team’s proposal began as a conversation between Roberts, Holmstedt, and Sami Al Kasab, M.D., assistant professor in the College of Medicine and project collaborator, about equipping ambulances with a new, portable version of a magnetic resonance imaging (MRI) scanner. This would allow a patient to be scanned while on their way to the hospital. Doctors at the patient’s destination could analyze the scans and decide whether to administer tPA, further cutting down the time to treatment.

To many, this idea initially seemed like a long shot. While the portable MRI scanner had proven useful for imaging patients in emergency departments and intensive care units, no one before Roberts had thought to install it in a vehicle.

“My long-term vision is to find a way to get the portable MRI qualified for space flight and to be used on future missions to the International Space Station.” -- Donna Roberts, M.D..

“Dr. Roberts asked me several times if it could be done, and to be honest I was kind of skeptical,” said Holmstedt. “Before I knew it, they had put the MRI in the back of an ambulance, drove around and took pictures. And our jaws just dropped.”

While so called “high-risk” ideas such as Roberts’ have great potential for improving medical care, their long-shot approach can make it hard to attract the funding needed to test them properly. The Blue Sky Award was instituted by Lori McMahon, Ph.D., vice president for research at MUSC, in partnership with the MUSC Office of Innovation, to encourage and reward such innovative and collaborative thinking.

“The fact that there was the opportunity to apply for this award was what brought us all together and motivated us,” said Roberts. “It’s great to talk about something in a hall. But when you’re working toward a common goal, it’s really helpful.”

 

The team began to develop the relationships that would be needed to test the feasibility of Roberts’ idea. In addition to Roberts, Harvey, and Holmstedt, collaborators grew to include representatives from the MUSC departments of Emergency Medicine, Neuro-endovascular Surgery and the Center for Telehealth, in addition to Charleston County Emergency Medical Services.

“There wasn’t anyone that we could think of that we invited into this project who wasn’t totally excited about it,” said Holmstedt.

The funding received from the award will enable the team to test whether the portable MRI can be mounted in a functional ambulance in a cost-effective way and operated efficiently by emergency medical providers.

“We want to make sure that this is an intervention that is effective and feasible, but also sustainable and cost-effective for the patient and the healthcare system,” said Harvey.

“We want to make sure that this is an intervention that is effective and feasible, but also sustainable and cost-effective for the patient and the healthcare system.” -- Jillian Harvey, Ph.D.

If it proves feasible and cost-effective to mount a portable MRI in ambulances, the team would like to conduct larger, randomized studies to confirm its usefulness in South Carolina counties where need is greatest.

Roberts’ vision for realizing the full potential of portable MRIs doesn’t end with stroke care. She thinks vehicle-mounted MRIs could be used for trauma evaluations and military medical evacuations. But Roberts, who also studies the effects of space flight on astronauts, is most excited about how the portable MRI could be used to monitor astronauts’ brain health.

 “My long-term vision is to find a way to get the portable MRI qualified for space flight and to be used on future missions to the International Space Station,” she said.