Research Improving Diagnositc Imaging in the ER

Adela Cora 00:03
We need to progress as a society. And we need to improve health care for us, for our families, for you know, everyone around us.

Steven Beyea 00:16
I could see the impact. And I thought, you know, this is an opportunity to head in this direction where I can take playing with some really cool physics. But have it actually become something that changes somebody’s life hopefully someday.

Stephanie Reid 00:38
Welcome to Beyond Research. I’m your host Stephanie Reid. There are many challenges impacting a healthier population here in Nova Scotia: physician recruitment; access to primary care; an aging population; infrastructure, equipment and facilities renewal; and increased costs for health care research and delivery. In this episode, we have a fabulous conversation with Drs. Steven Beyea and Adela Cora on their research in local emergency departments to help address some of these challenges. This type of project really gives you an inside look at how that research can provide benefits to end users in real time. Sometimes, we may think research has no impact on my life. But our guests today shine a light on just how much of an impact research has on our daily lives as Nova Scotians.

Steven Beyea 01:27
I basically grew up literally hanging around medical imaging. So my father was head of nuclear medicine at a hospital in New Brunswick, and when he was on call as a little kid, I hung around. It was the 70s.

Stephanie Reid 1:42
Just a normal childhood.

Steven Beyea 1:44
Exactly.

Stephanie Reid 01:45
This is Dr. Steven Beyea from the IWK Health Centre in Halifax, Nova Scotia. He is leveraging his medical imaging research program to improve MRI accessibility and diagnostics in an emergency setting. By facilitating access to novel medical technology, his work has not only led to the installation of cutting-edge technologies in local hospitals, they’re poised to improve diagnostics, reduce wait times, and in some cases, eliminate the need for secondary surgeries.

Steven Beyea 02:12
A key part of what we do is that we are sort of foundationally interested in not just creating cutting edge technologies, but also working with industry partners and clinical partners to figure out how a new technology is not just better technology, is it better healthcare and if it’s better health care? How do we get that out into the world via partnering with industry in particular with Canadian industries and Nova Scotian industries that then allow us to take the research that we’re doing and get out into the world.

Stephanie Reid 02:47
Dr. Beyea research has attracted millions of dollars in investment by multinational enterprises such as Elekta Neuroscience and NGE Healthcare, and driven validation of novel medical technologies from small and medium enterprises like Synaptive Medical.

Steven Beyea 03:02
In science, research papers are the currency by which we communicate what we do, but research papers don’t treat patients. And so the only way we can actually have the impact that we have is if we figure out how not only to turn this into a research paper, but how to turn it into something that can actually impact healthcare. And we do that by partnering with healthcare providers like Dr. Cora, and the outstanding work that they do, as well as with industry partners, such as Synaptive Medical, as an example. They were the ones that led the concept and engineering design of this. It’s an MRI, but not exactly the same as the typical MRI that you’d be used to seeing. It’s one that is engineered from the ground up to be optimal for things like neuroimaging, and in particular, applications like rapid screening that might be needed in urgent care situations. It’s a very different type of MRI than that which we’re usually using in diagnostic imaging. We have a healthcare system that needs innovation. We need new technologies to help us innovate. Industry has innovations. But to test them, you can’t develop a medical technology outside of the medical environment, and they need partners within healthcare. And the other the other piece of that then is academia and those new discoveries that then feed into what are those ideas that would allow us to do things like image faster, as an example. And so in all these projects, we have graduate students and postdocs and undergraduate medical students and so on, who are involved in this from an academic perspective, driving new discovery, partnering with healthcare that then allows us to evaluate this in a healthcare setting, partnering with industry who can bring new innovations to the table that they need validated in healthcare. It’s a three legged stool and we need all three legs.

Stephanie Reid 04:57
We’re also joined today by Dr. Adela Cora. Dr. Cora is an undergraduate medical education program director for diagnostic radiology and an active, practicing physician in the neuroradiology section of the QEII Health Sciences Centre in Halifax, Nova Scotia.

Adela Cora 05:15
Basically, in my day-to-day job in the hospital, I basically diagnose X-rays, MRIs, CT scans for people that have diseases of the brain and spine mainly. And then I also do research on kind of similar topics. Stroke is one of the things that I kind of like to do research on especially. And then also, I am the undergraduate medical lead for radiology. So I’m also part of Dalhousie University, and I teach there as well.

Stephanie Reid 05:50
So you have nothing going on at all, you have to be incredibly busy. So for people listening, who may not understand what an MRI is, at its core, can you just break that down.

Steven Beyea 06:01
Really at its heart, MRI, magnetic resonance imaging, involves a strong magnetic field, and the use of radio waves going through, really, frankly, some funky quantum mechanics, there’s a whole bunch of physics that’s happening in the background, which is the stuff that gets physicists like me excited. But really just using this combination of a magnetic field in a radio wave, we’re able to create pictures of what the inside of the body looks like. And in particular, the thing that makes MRI so powerful, is it lets us take pictures in which we can tell the difference between different types of tissues in the body and more to the point between healthy and not healthy tissue in the body. Ultimately, then MRI is from diagnostic imaging perspective, one of the best tools that we have for doing clinical diagnosis of the soft tissues within the body. If you watch shows on television of Grey’s Anatomy or whatever, often then it’s patient sliding into a long tube, and you hear various bangs, and so on. And that’s the sound of an MRI working. In this case, the MRI is a bit different. It is very small, it’s maybe three feet by four feet, it’s very light. So the normal MRIs get picked up by cranes to be delivered to hospitals, this one came in on a little hand truck. And it also has a far weaker magnetic field. While no, it’s not mobile, but it is small footprint, light weight in for various technological reasons, much easier to place in different environments within the hospital compared to a traditional MRI.

Stephanie Reid 07:51
Right. So you wouldn’t have to build like a new add on or addition to an existing

Steven Beyea 07:55
Right. Many MRIs, the traditional ones literally weighs 12 tonnes and need to sit in a really large room with reinforced flooring and so on and so on. So all of that then fed into the engineering design reasons why Synaptive Medical did what they did.

Stephanie Reid 08:20
So Dr. Cora, you’ve been working with Dr. Beyea since 2019, on a variety of research projects, this particular one is taking place in the emergency department; can you explain what that looks like for patients walking through the door?

Adela Cora 08:33
Let’s talk about stroke, for example. And so stroke is important because it is the leading cause of patients being dependent on others after having a stroke. So being able to treat them quickly is really important. And one of the treatments that has been developed since about 2015 is an interventional treatment where we can go through the arteries to the brain. And if there’s a clot there that blocks the artery and blocks the blood flow to the brain, remove that clot. So as part of that, you know, everything needs to be done very fast. And so it’s really important to get to the diagnosis to know that, you know, there is a clot there, for example, really quickly. And so currently we use CT. And so if someone has a large stroke, typically CT would pick that up, generally. But if someone has a smaller stroke, and the clinical signs and symptoms are not so clear cut, I think it’s especially at that point that having the MRI scan done, and then saying oh yes, look, there’s a stroke here and now we’re going to start treatment right away, rather than kind of waiting a little bit and saying, okay, we think it’s a stroke. Obviously, all treatments have, you know, potential side effects and complications and there is contraindications. So really, the clinicians want to know, you know, what is the diagnosis before embarking on a treatment.

Stephanie Reid 09:57
So Dr. Beyea, this research project centers around that partnership with Synaptive Medical. Can you tell us a little bit about how that partnership came to be, how that started, and how you were successful in bringing this technology to Nova Scotia.

Steven Beyea 10:11
It started with myself and Dr. David Clark, who’s the Chief of Neurosurgery at NSH, getting on a plane and flying to Toronto, walking into their boardroom and saying to the president of the company, we want to be your first adopter. We think that Halifax and Nova Scotia is the place where you should put the very first MRI of this type that you’ve ever made, because we want to be the innovators and early adopters who bring this into the health care centre. And so that’s where that started. And moving forward through the tremendous support of various organizations, but in particular Research Nova Scotia, that then led to us having here in Halifax, the very first of these MRIs in the world.

Stephanie Reid 10:56
So Dr. Cora, this technology right now is part of a bigger research program, but if this technology is implemented in the department long term, what kind of impact does that have on capacity of not only the emergency department, but also the health system.

Adela Cora 11:11
In terms of the clinical kind of utility of this, it’s really amazing because with the amount of patients we have in hospital, and patients that come for scans every day, I think it would be really easy to fill the scanner to run for a full day. And so what that would, what would happen is that then we would have space on the other scanners, the 1.5 and the three Tesla scanners. And so patients that need that scanner, more or, you know, we would be able to scan them there. And also so that means overall, we would increase our throughput by a third, basically, because we would have one additional scanner. So that is powerful.

Stephanie Reid 11:57
If the research shows what we think it’s going to show, how easy will it be for health centres to adopt this technology in their emergency departments?

Adela Cora 12:06
The cost of this MRI because it is smaller, everything is not as expensive in terms of the machine itself, but also running it on a day-to-day basis. For example, if we have a patient that comes into the hospital, they will typically be first investigated with a CT scan. And then if that doesn’t give us the answer, and they still need to be in hospital, then a few days maybe down the line, they will have an MRI. So in terms of the scanner, because it’s so kind of light, portable, in a way could be placed right next to the emergency department, potentially patients could skip a step and kind of go straight from the emergency department to this scanner, and then have this scan and have a diagnosis that is in a shorter time period. And so what that means is one that they could potentially start treatment faster. But also in terms of the financial gain of that if we have a patient that can be diagnosed and start treatment right away and then go home, well, then maybe you don’t have a patient that needs to stay in hospital for a few days. So that is a huge financial advantage.

Stephanie Reid 13:12
So Dr. Beyea, this MRI is small, but the value is big, even though it may not be the same level of picture that the traditional MRI would show, can you talk about that value, especially in the emergency room setting.

Steven Beyea 13:26
I think to take stroke as an example. So Dr. Cora alluded to this idea of creating these really rapid screening exams. And so this idea of a very different use case for MRI, in which in that example, all we really need to know in that moment is is there a stroke? Yes or no? If the answer is no, we don’t in that moment necessarily need to know what else it might be. If it’s a stroke, we need to know need to know that right away if it’s something else, and that can be dealt with in a less costly, less urgent way down the road. But every patient that we don’t have to send for a traditional, most brain exams are 20 minutes long. Every time we can keep a patient from occupying one of those slots is an opportunity for us to decrease the wait time list that we that we have, because now we are freeing up slots to do these other things. There’s a part of all of this in terms of the flavor of where research is going is the recognition that we need to pay attention to the role of value and so sometimes we absolutely need you know, the really, just use MRI as the example, the really high magnetic field, expensive technology sometimes that is absolutely needed, but not always. And sometimes then the role that instruments like this can play is if it can answer the question, but do so in a way that is either faster or less expensive and so on and reach the exact same answer, then that’s better value to our healthcare system. And I think in the context of healthcare in 2023, that increasingly there’s this recognition that that’s a piece of it, it can’t just be better technology, it also has to be potentially better value to our healthcare system.

Stephanie Reid 15:20
So Dr. Beyea, how many research projects are leveraging this new MRI technology? And how are these projects continuing to evolve and add value for patients and caregivers?

Steven Beyea 15:30
I forget the exact number, but it grows every week. I, literally two weeks ago, had a meeting with Dr. Sam Campbell in the emergency department. And we’re out of that developing another brand new project in which we’ll be recruiting from the emergency department. The list is growing all the time, I think as well, you know, one of the things is that we have been able to evaluate along the way, as we do these projects, like the work that Dr. Cora’s doing on stroke and so on, is we’re now collecting these large pools of data. And that allows us as we build up the pools of data to bring in artificial intelligence, so the role that deep learning and AI can play in helping us make these images even better. Because one of the things is, as Dr. Cora alluded to, is that usually CT is seen as fast, MRI is seen as slow, that CT is seen as maybe not sensitive to things in soft tissues, like the brain versus MRI is, but there’s always trade offs. So we’re doing a lot of work in saying, how about we give up some of that image quality, and, but make it faster. So can we trade off some speed for some quality? And if it’s my mom, who is in that emergency department and needs to get imaging, I’m not going to give anybody artistic merit points additionally, for if the image was pretty, it doesn’t matter if it was pretty, was it good enough to reach the diagnosis? And so we’re looking at, can we make the MRI images that we’re getting with the scanner even faster, to provide even better value in this sort of a setting? And part of the way we do that is by bringing in things like artificial intelligence. And so there’s lots of these different almost side projects that are coming off as well. And can we take this? And oh, how about now we reconstruct the images, using AI and so on. And it just keeps growing and growing.

Stephanie Reid 17:33
Wow that’s incredible. I feel like there’s a million stories of how you’re leveraging this technology right now. And if you continue to see these positive results, do you see this becoming a new standard of care in an emergency room setting and or even outside of an emergency department?

Adela Cora 17:51
So I think yes, I think it has great potential. One of the main benefits of this is that it’s a smaller machine, easier to place next to the emergency department, patients can kind of go there, right away from the emergency department. And I think from from what I’ve seen, up to now, I think that this is going to be one of the next steps. With stroke, for example, once we finish this project, we’re going to try and see if we can get patients to go straight away through the MRI machine and maybe not having the CT scan, for example. The other thing I want to mention is that one of the strengths of this machine because the more you go like higher magnetic field, you can get more artifacts from things like implants. And so one of the things that we were talking about, and that’s kind of still in development, is whether we can assess implants that patients have in the brain with this machine better. So for example, because I do procedures as well, and sometimes some patients have certain diseases that need to have stents placed in the brain, similar like the heart, for example. And so those stents, once they’re placed, it’s really difficult to kind of image them. We get artifacts with CT and with MRI. And so typically, what’s needed is for them to have another procedure where we go from the groin and we kind of do a cerebral angiogram, that’s what that test is called. And then we can assess the stent and how it’s healing. And so, with this machine, I think there is the potential for us to be able to visualize those kind of stents better and see how the blood flows and whether it’s all kind of healed nicely and you know, it’s kind of management in terms of what medications these patients need. But so, if we’re able to save a procedure for a patient, then again, that is a big thing.

Stephanie Reid 19:57
And I can tell by how happy your faces are, how exciting it is.

Steven Beyea 20:01
There are now hospitals in Canada that are now buying this and adopting it. But we were the first adopter, we were the leaders in this particular field. And I think it’s a great success story for Nova Scotia, that it wasn’t Toronto or Montreal or Vancouver that led this and we followed. We have led along with this Canadian company, the clinical implementation and testing of this technology.

Adela Cora 20:27
I’m looking forward to being able to use this on a clinical kind of setting on a day-to-day basis, because I think it has lots of advantages, you know, all this development, all this research. And I think we need to move from that to the clinical side and be able to use this on a day-to-day basis and benefit our population here in Nova Scotia.

Steven Beyea 20:52
Technologies like this are coming. And we can either wait until Boston, New York or whatever develops it, and then someday down the road, when other people’s patients have already benefited, we can pay full price, or we can be the leaders and say, we want to plant our flag here in Nova Scotia and say, we are innovators here and we can play a role as the early adopter. So my hope is that this becomes not a single example, but that we could fill a podcast with group after group coming in and having the same sorts of stories about the ways in which we can innovate in healthcare by marrying academia and healthcare and industry partnership.

Adela Cora 21:43
Research matters because it’s what drives us forward. We don’t want to be followers, we want to be leaders, and we want to improve health care. And it’s a lot of work, but it’s worth it.

Stephanie Reid 21:59
As you heard Drs. Beyea and Cora are passionate in their desire to positively impact those around them. They are helping to create an environment that is conducive to the creation of the next generation of researchers, clinicians and entrepreneurs who understand the complexities of working in our healthcare system. In Dr. Beyea’s lab, this has resulted in students eager to contribute to both healthcare and economic development. Most importantly, it’s demonstrating how strong partnerships in healthcare research can improve patient care sooner.

Stephanie Reid 22:42
We hope you enjoyed today’s episode. Be sure to hit the subscribe button and leave us five stars. You can also follow us on Instagram @beyondresearchpodcast and let us know what research topics you would like to hear on the podcast. Thank you for listening and we’ll see you next time.