Can Israeli AI smartphone app diagnose strokes from afar?

The stroke unit at Jerusalem’s Shaare Zedek Medical Center (SZMC) is the first in the country to test clinically a smartphone device using artificial intelligence (AI) to perform a neurological examination based on the patient’s voice and a video recording of the face and other parts of the body, process them and diagnose stroke cases in minutes.

Called CVAid Medic, it was invented by the CVAid company established five years ago at Ramat Hahayal in Tel Aviv. Until now, the company has been working on development with stroke experts in the US, Spain and Germany. It expects that the technology will turn commercial for use by paramedics in ambulances and medical teams in hospital emergency rooms and stroke units – in less than two years. 

The company says the technology will provide the triage clinician with a tool for immediate diagnosis, with a high degree of accuracy of whether the patient has had a stroke and how severe it is, with an accuracy rate of about 90%. 

Dr. Roni Eichel, the head of SZMC’s stroke unit and the neurological intensive-care unit, told The Jerusalem Post that there is a shortage of brain surgeons who are able to use catheters to overcome clots in the brain, less in pint-sized Israel but especially in the US, Europe and elsewhere where distances from hospitals are significant. Getting relevant patients to hospitals in time can prevent paralysis and other disabilities and death. 

As part of the experiment, Eichel’s unit will use CVAid system’s ability to accurately track, quantify and compare the degree of neurological improvement in the patient after catheterization or drug treatment compared to his condition before treatment.

About 15 million people around the world – and 850,000 in the US alone – suffer an ischemic or hemorrhagic stroke (cerebral vascular accident or CVA) in a single year, but only a tenth receive the required medical treatment. Of the 15 million, a third die and another five million are permanently disabled.  

The more common ischemic stroke is caused by a blockage cutting off the blood supply to the brain, while a hemorrhagic stroke is caused by bleeding in or around the brain. The CVAid Medic device, said Eichel, can identify both types and in both men and women. 

"Time is brain"

“Time is brain,” the SZMC stroke expert continued.

“The sooner the stroke victim is treated, the more likely he is to recover. Symptoms of a stroke depend on the area of the brain affected. Symptoms of stroke include trouble walking, speaking and understanding, as well as paralysis or numbness of the face, arm, or leg. Early treatment with medications like tPA or mechanical thrombectomy (removal of the clot) can minimize or even eliminate brain damage,” he stressed. 

CVA-Flow is a comprehensive telestroke system that ensures early and accurate diagnosis of stroke by certified neuro teams using a standard smartphone and dedicated cloud servers. The CVA-Flow, supported by its AI module (CVA-Core), synchronizes all stroke stakeholders.

The prediction is based on the data of over 500 stroke patients. “It may even provide a more accurate stroke diagnosis than a neurologist,” Eichel added. 

The concept of analyzing the voice to diagnose strokes has been discussed for the last five years or even a decade by doctors, hospitals and hi-tech companies, Eichel explained. “But they didn’t really succeed. CVAid has so far been more successful. We were very pleased when the company turned to us to work with them. Our four senior doctors who do brain catheterizations around the clock perform 110 procedures a year, and in 85% of them, they open up the clogged artery in the brain.” 

In many countries including Israel, ambulances tend to bring stroke victims to the nearest hospital even if they don’t have the facilities and the neurosurgeons on duty to handle them. Forty percent of stroke victims are brought directly to hospitals by relatives or friends. The smartphone application reduces late arrival to suitable hospitals and false positive and false negative diagnoses and enables achieving timely life-saving treatments, Eichel asserted.

“By correlating clinical records with audiovisual output, we created algorithms that automatically classify urgency in real-time, assisting neuro teams at stroke centers to remotely diagnose stroke patients and provide appropriate evacuation location and therapy,” said company CEO Oren Dror, a business development specialist with over 20 years of extensive global experience in healthcare who earned a BA degree in economics from the Hebrew University of Jerusalem and an M.Sc degree in industrial engineering and management from Ben-Gurion University (BGU) of the Negev in Beersheba. 

“Our all-in-one software solution analyzes data in real-time, providing neuro decision-makers with the support tools required to remotely diagnose patients without sacrificing quality,” said Dror, who is one of five cofounders of the company. “We chose SZMC because Roni Eichel is well known for his specialty and SZMC is one of the country’s leading medical centers.” 

He added that the company started testing at the Rambam Health Care Campus “because our chief medical officer worked there, but it was not for regulation or publication. The collaboration with SZMC is the first independent validation and clinical study, and we will publish our findings.” 

The team made a video of patients twice – when they reach the emergency room for treatment and then a day later, after treatment – to see the objective differences from an acute to a subacute situation. “I think this is the first in the world.”

The company will allow dispatch emergency medical services like Magen David Adom and United Hatzalah to use the system, while hospitals will purchase the whole platform. In the long term, people at high risk for stroke will be able to purchase the right to use the app and be in direct contact with their physicians, just as the Israeli companies Natali and Shahal provide devices for early detection of heart attacks. 

“We are innovative company, and the Israel Innovation Authority has been supporting us for a second year. The US Food and Drug Administration has recognized us as a unique technology,” Dror added. 

Dror is one of five co-founders of the company; the chairman is Danny Farin, who has a degree in biotechnology engineering from BGU and a master’s of business administration from Tel Aviv University (TAU). 

“We are thrilled to collaborate with Dr. Eichel and this team at SZMC. This is a milestone step which continues experiments we conducted on hundreds of patients in major medical centers globally aiming to create an innovative technology platform in the diagnostic processes of stroke events,” Dror told the Post.

 “We are progressing according to our strategic plan which includes completing the regulatory processes with the FDA and the European CE, continuing the clinical studies and recruiting additional quality personnel to the company in order to expend our activity in the American and European markets.”