Improve detection thresholds for intracranial haemorrhage and large vessel occlusion stroke in near-infrared based portable brain scanning

Minutes count for patients1 who require emergent neurological surgery or neuro-endovascular intervention to prevent death or permanent, severe disability. The <10% who need surgery among the many suspected injuries are found using imaging in A&E Departments, but only 1 in 6 of A&Es have surgical/endovascular services.2 Subsequent secondary transfers to surgical centres from the other 5 A&Es introduce hours-long delays and waste ambulance resources. We are developing Vascascope, a portable, wearable near-infrared spectroscopy (NIRS) brain scanner to diagnose and monitor brain injuries. Our first applications are surgically-significant emergencies: large vessel occlusion stroke (LVOS), and extra/sub-dural haematomata (EDH/SDH). By empowering prehospital providers to stream appropriate patients directly to neurosurgically-equipped centres, Vascascope could save 2,180 LVOS patients/year from disability in the UK.3 Care costs would fall by £132k/patient plus £25k/patient per subsequent year of disability-free survival.4 Over 5 years, this would save the UK Department of Health and Social Care £2bn. NIRS has been used for three decades to study functional activation,5,6 (similar to functional MRI). NIRS devices send harmless near-infrared light through the outside of the head, mapping blood and oxygenation. Typical NIRS does not have the spatial resolution for medical imaging.7 Vascascope uses a high channel density, and innovative high signal-to-noise electronics to enable spatial resolution sufficient to diagnose brain injuries that show effects on the peripheral 3.5cm of the head such as LVOS and EDH/SDH. The device is UKRI STFC TRL 4-5: we have demonstrated that we can detect diminutive 5x5x1mm bleeds in biomimetic phantoms through artificial skulls and create 3D images that accurately represent the phantoms. Our capability forecasts are supported by patient data from Dr. Leonard Yeo (National University Hospital Singapore) using commercially-available NIRS devices. We expect to demonstrate both the detection of small structures plus further functionality in healthy volunteers before the end of the year. We have all sub-systems in place (mechanical, electronic, software/imaging) and are currently working on integration. Following this internal demonstration, we will enter a clinical study with the device. This project is aimed at a significant addition to our imaging contrast (note: without using injected contrast agent), enabling both better spatial imaging (our current capability) and new contrast for different tissues/phenomena not possible before. Obtaining these new abilities now would significantly improve the chance of a successful clinical study outcome and commercialisation of the device. This project will use cardiorespiratory oscillations, which are typically ignored or removed from NIRS data, to derive extra parameters to identify "pixels" within our image such as skin, skull, brain and blood. We have an active PPI group, recruited with the NIHR HealthTech Research Centre in Brain Injury, that provides input on device design and project activities. Our key feedback to date has been on improving the patient experience and comfort. The group will meet in February and we can expand the meeting s scope to include this project (at no additional cost). We have world-leading clinical advisors and have iteratively sought wider stakeholder views (e.g. paramedics, clinical engineering, hospital IT).