How a team of Chattanooga neurologists helped develop and launch a groundbreaking smartphone application to hasten stroke care

Photography by Jennifer McNally / Neurologists Dr. Tom Devlin, left, and Dr. Ruchir Shah, and neurosurgeon Dr. Mayshan Ghiassi, gather in the procedure room where they perform life-saving surgeries for stroke patients at CHI Memorial.
Photography by Jennifer McNally / Neurologists Dr. Tom Devlin, left, and Dr. Ruchir Shah, and neurosurgeon Dr. Mayshan Ghiassi, gather in the procedure room where they perform life-saving surgeries for stroke patients at CHI Memorial.

Chattanooga is a city that "likes to punch above its weight class," as the saying goes. And when it comes to artificial intelligence (AI) technology, The Scenic City has yet another hidden gem of extraordinary accomplishment.

Dr. Tom Devlin and Dr. Ruchir Shah, both neurologists with CHI Memorial, were involved in the development and launch for VIZ.ai, a groundbreaking smartphone application designed to hasten stroke care.

Strokes occur when blood flow to the brain is disrupted. With every minute that passes, an estimated 1.9 million brain cells are lost. Restoring that blood flow is essential to preventing lifelong disability or death.

Since its launch, VIZ.ai has been shown to knock 39.5 minutes off the time from when patients are diagnosed as having a stroke, to the time they receive medical intervention, says Devlin, who is also the medical director of the Chattanooga-based NeuroScience Innovation Foundation (NIF), which co-led the research.

"This happened in Chattanooga," he says. "This is a Chattanooga story."

  photo  Photography by Jennifer McNally / CHI Memorial neurologists Dr. Ruchir Shah, left, and Dr. Tom Devlin utilize the VIZ.ai phone application, which allows stroke care professionals to instantly access patient brain imaging within seconds after CT scan completion.
 

"There is no doubt, this has been a game changer," says Shah, stroke program director for NIF.

Holding his smart phone, he uses the VIZ.ai application to view the three-dimensional brain scans that are shared with hundreds of doctors who are also part of the network. The images are easily manipulated -- moved up, down, side to side, diagonally -- so members of the stroke team can see the scans at all possible angles.

Another incredible part: Those images are available to all clinicians within the network within seconds of the CT scan being taken, revealing details that would otherwise be impossible for the human eye to detect.

Shah was the first doctor to use the VIZ.ai software to detect a stroke in a patient. At the time, the patient lived in Dalton, a smaller North Georgia town with a hospital that isn't equipped with the same technology found in Chattanooga.

Through VIZ.ai, Shah noticed the patient's clot within minutes of her CT scan. Just minutes after that, she was transported to Chattanooga for life-saving surgery.

Devlin recalls the day: "As soon as the app went off, we saw the alarm, and he called the hospital in Dalton. We very quickly got the patient out of the (Dalton) hospital. The patient came up here, had a thrombectomy, and went home within a couple of days."

Many medical experts agree AI has already transformed modern medicine, and as we generate more data, its impact will only grow. Data-driven technology is being used to help discover new medicines, predict diseases and accelerating drug research.

Wearable devices such as Fitbits and smart watches are being used for early detection and prevention for a broad range of health issues. And smart insulin pumps, for example, have been used for many years now, helping type 1 diabetics live better lives.

But the potential of AI comes with its own set of challenges. Properly utilizing AI will require adequately training workforces, addressing ethical and privacy concerns, and educating patients on how to use the technology.

"The world went crazy for AI about a year ago. But the truth is, it has been used in business and health care for probably at least a decade or so," says Deborah Mullen, the Greg Vital – Franklin Farrow Associate Professor in Healthcare Administration at the University of Tennessee at Chattanooga.

  photo  Contributed photography / Deborah Mullen
 
 

 So, as we move forward, will AI technology come at us like a speeding locomotive, or will it progress more like a steady stroll?

Mullen suggests it will likely be a blend of both, depending on how the technology is to be used. Less risky endeavors, like scanning vast data sets, may progress faster, while high-risk implementations, like those in insulin pumps, may proceed more cautiously, with slower roll-out times.

Mullen predicts that AI will primarily serve as an assistant, tackling time-consuming and labor-intensive tasks like counting microscopic cells or detecting infections. While AI can expedite certain processes, human verification remains essential.

"I don't think AI will replace people, but it makes people more efficient and has the potential to free up time so people can do the things that people are good at," she says. "Most people would not want a computer to take over everything. When there is a diagnosis, we still want a human delivering that message."

In the realm of health care, emotions run high, she says. It's a costly endeavor, and people are grappling with concerns about their well-being. While seeking medical care, what people want and need above all else is not just solutions, but the human touch.

  photo  Photography by Jennifer McNally / CHI Memorial cardiologist Dr. Vimal Ramjee studies an AI-generated image of the heart.
 
 

 "After many years working in health care, I have found the main reason most health care workers go into this field is the caring part," she says. "Helping people make decisions based on values and what they want for their lives.

"I've never met a nurse or doctor who said, 'You know, I just love sitting at my computer, typing in thousands of fields of data.' With AI, we can hopefully get rid of some of the stuff that keeps us from having those relationships and interactions."

Similar to that used in stroke care, CHI Memorial cardiologist Dr. Vimal Ramjee also uses AI to help screen for abnormalities.

"We use AI technology as part of our coronary CT scan. This allows us to look at vessels in great detail, to see if someone has blockage or not, and whether they may need medications or something bigger like surgery," he says. "It's been extremely powerful and enabled our program to thrive."

Ramjee relies on AI daily, especially for interpreting CT scans, a routine yet critical task. Beyond imaging, AI has diverse applications, including the detection of aortic tears or pulmonary embolisms.

For instance, calcium deposits in blood vessels can hinder blood flow, but are nearly impossible for the eye to detect. In these cases, AI is useful in quickly identifying these restrictions to flow, which help Ramjee with a confident diagnosis and prompt referral for patients who might have serious conditions.

He offers an example involving a middle-aged male patient who had been experiencing chest discomfort. After undergoing a stress test with initially reassuring results, the patient returned with persistent pain. A coronary CT and AI technology revealed multiple blocked vessels, prompting life-saving open-heart surgery.

"No tests are perfect," says Ramjee. "And neither is AI. But it really can add value."

Erlanger Health urological oncologist Dr. Amar Singh points out that AI is changing health care in a multitude of ways.

One example would be monitoring blood pressure.

Before AI, patients would need to visit their primary care physician. There, someone from the office would check the blood pressure, make note of it, and based on the results, dial medications either up or down.

Now, that information can be automatically sent in and medications adjusted, he says. Using wearables like a smart watch, a person's blood pressure can be continuously fed into a system. And those sorts of common procedures, like checking blood pressure, are going to become increasingly mainstream.

  photo  Contributed photography / Erlanger Health System's urological oncologist Dr. Amir Singh stands beside the robotic high-intensity focused ultrasound technology used in prostate cancer treatment.
 
 

Currently, AI technology is applied in treating prostate cancer using "robotic high intensity focused ultrasound." In the past, relying on human operators led to potential injuries to surrounding areas like the rectum, Singh says. Now, the computer identifies the safe zone, distinguishing what tissue to preserve and what to remove, minimizing risks with a built-in safety mechanism.

Data-driven technology enhances safety during operations by minimizing complications and adverse outcomes, he says. It mitigates human error, making procedures safer through technological intervention.

In his practice, another example involves using a stapler to pinch off and divide tissue.

Before, surgeons didn't know if the staple pressures were adequate. Now, with robotics, there are sensors built in to help determine the amount of tissue, which helps prevent taking too much or too little.

"These are all just in the last five years that we have seen come out," says Singh. "And they have minimized error rates and complications, and are helping people get better sooner. There are aspects of these all over in surgery."

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