How can Teleradiology be Leveraged for Early Stroke Diagnosis?


Technology is rapidly evolving and leading the way. As a result, many other medical specialties are catching on to the benefits of teleradiology. Recently, one of these fields has started to see its value: Early diagnosis of stroke.

In India, the burden of stroke is increasing. Stroke is now the 4th leading cause of death and the 5th leading cause of disability. Previous research suggests that the incidence of stroke ranges between 105 and 152/100,000 people per year. In stroke, awareness of the symptoms and immediate assessment by a medical professional are crucial to treating and recovering from the disease. Unlike heart attack, where pain is a prominent symptom, stroke patients often ignore minor symptoms like sudden weakness or numbness. When it comes to stroke, minor attacks (Transient ischemic attack) serve as warnings for more severe strokes (cerebrovascular accident or CVA). Treatment decisions in acute stroke require ultrafast imaging procedures. These should be completed immediately after clinical triage and emergency stabilization of the patient.

Therefore, it is important to diagnose a stroke as soon as possible, since early treatment decreases the likelihood of death and severe brain damage. The Golden Hour concept refers to the fact that if treatment is instituted promptly, the chances of survival and avoidance of long-term brain damage are significantly lower.

When a patient is brought to the hospital with a stroke, imaging can begin with a simple question: Ischemic stroke versus hemorrhagic stroke? The answer to this question is most often given using a plain CT scan of the brain. This type of scan aims to exclude bleeding and established large infarcts, which are contraindications for intravenous thrombolysis (IVT). 

The challenge of this advanced imaging is that while extremely accurate, it produces a very large amount of data that must be analyzed quickly. And the greater challenge is that radiologists, who are in short supply worldwide, are often not easily or quickly available on-site at a hospital when a patient with an acute stroke arrives.

Brain CT showing acute infarct

Here enters the role of AI-powered teleradiology solution. Teleradiology is a technology that brings the radiologist’s interpretation of imaging studies to the patient, who may be anywhere. This allows patients to get their scans interpreted as quickly as possible, which can help them avoid serious medical complications. Artificial Intelligence (AI) is the new and exciting area in diagnostic radiology today. Digital radiographic images are binary, this makes them suitable for computer analysis using deep learning algorithms to detect specific patterns.

In the management of stroke, it is important to differentiate between hemorrhagic and ischemic strokes. The use of AI algorithms can identify bleeding within the brain instantly. This instantaneous detection allows the bleeding to be brought to the radiologist and neurologist’s attention, so they can make an immediate diagnosis and determine the appropriate treatment.

The use of artificial intelligence also assists in analyzing perfusion imaging to determine how much brain tissue has already been irreversibly damaged, as well as predicting the value of blood thinning medications (TPA) and likely outcome of treatment. This analysis is important because it helps establish prognosis for recovery. Furthermore, AI can identify the precise location of a vessel blockage, which helps the neurologist determine whether a patient will benefit from mechanical thrombectomy. This procedure involves introducing special equipment into the blocked artery to break up and extract the clot.

Teleradiology can be a very effective tool in acute stroke if time is of the essence, and structured reports are created. This will help avoid medico-legal consequences and guide physicians in making treatment decisions. 

This article is co-authored by Dr. Sanjay Yuwanati (MBBS, MD), Senior Consultant Radiologist at 5C Network.

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